For women who are at an elevated risk of developing breast cancer, prophylactic mastectomy is an option to reduce this risk. Prophylactic mastectomy been shown to reduce the risk of breast cancer by over 90% in women with a BRCA1 or BRCA2 mutation. There are various types of prophylactic mastectomy that can be performed, which may or may not include the removal of the nipple and/or areola along with the breast tissue. There may be aesthetic advantages associated with the maintenance of the nipple and/or areola.
Women are concerned about the final cosmetic result associated with prophylactic mastectomy, about retention of breast sensation and operative and post-operative morbidity. For most, preservation of body image is the critical factor in deciding against the operation. Research has suggested that the cosmetic results of subcutaneous mastectomy may be better than those in which the nipple and areola are removed. Gerber et al. (2003)6 compared women with skin-sparing mastectomy, with and without preservation of the nipple and areolar complex. The aesthetic results were evaluated by both the patients and independent physicians. The majority of the cases were evaluated as excellent or good. However, 20% of the cases without the nipple/areolar complex preservation were evaluated as fair compared to none in the nipple/areola complex preservation group (p=0.001). While studies such as this suggest that the majority of women and physicians are satisfied with the cosmetic results of subcutaneous mastectomy, we do not have adequate data comparing cosmetic outcomes of total versus subcutaneous mastectomy for breast cancer prophylaxis. Women who consider prophylactic mastectomy generally assume that the cosmetic outcome will be superior if they are able to preserve the nipple-areola complex. More long-term research is needed to examine the psychosocial outcomes associated with the various types of prophylactic mastectomy to provide more accurate counseling to women considering this preventive surgery.