A 32-year-old BRCA2 carrier undergoes risk-reducing bilateral mastectomy. She requests nipple-sparing mastectomy (NSM). Which statement about NSM in risk-reduction is most accurate?

• A NSM is absolutely contraindicated in BRCA carriers as residual retroareolar breast tissue negates risk reduction
• B NSM must be followed by sentinel lymph node biopsy in all BRCA carriers
• C NSM is only acceptable for BRCA2 carriers, not BRCA1
• D NSM achieves similar risk reduction to total mastectomy if the retroareolar core biopsy is negative and adequate margins are obtained ✓

Explanation

Nipple-sparing mastectomy (NSM) is oncologically acceptable for risk-reducing surgery in BRCA carriers provided the retroareolar tissue core biopsy is clear of occult malignancy and adequate surgical margins are achieved. Risk reduction is similar to total mastectomy (approximately 90-95%), with superior aesthetic outcomes and preserved nipple sensation. NSM is offered to both BRCA1 and BRCA2 carriers without preference distinction. Sentinel lymph node biopsy is only required if an occult invasive cancer is found on specimen analysis, not routinely.

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.