A 40-year-old BRCA1 mutation carrier undergoes risk-reducing bilateral salpingo-oophorectomy. She subsequently opts for prophylactic bilateral mastectomy. The surgical option that offers the lowest residual breast cancer risk while preserving the best cosmetic outcome is:

• A Skin-sparing mastectomy with immediate implant reconstruction
• B Simple mastectomy without reconstruction
• C Nipple-sparing mastectomy with immediate implant reconstruction ✓
• D Subcutaneous mastectomy preserving the retroareolar tissue

Explanation

Nipple-sparing mastectomy (NSM) removes all breast parenchyma through a peripheral incision while preserving the skin envelope and nipple-areolar complex, offering residual risk < 2% in BRCA carriers without prior nipple involvement. Simple mastectomy without reconstruction has equivalent oncological result but inferior cosmesis. Subcutaneous mastectomy retaining retroareolar tissue leaves the highest volume of residual breast tissue and is not recommended prophylactically.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.