Josephine A D'Abbondanza1, Ralph George2, Sari Kives3, Melinda A Musgrave1,4. 1. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 2. Department of General Surgery, CIBC Breast Centre, St Michael's Hospital, Toronto, Ontario, Canada. 3. Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada. 4. Division of Plastic and Reconstructive Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
Abstract
PURPOSE: There are limited data on coordinated breast and gynecological risk-reduction surgery for high-risk patients in Canada. Therefore, this study aims to evaluate the patient demographics, surgical details, and outcomes of prophylactic mastectomy (PM) with immediate reconstruction and bilateral salpingo-oophorectomy (BSO) in high-risk patients. METHODS: We conducted a retrospective chart review at an academic center of patients who concurrently underwent PM with immediate reconstruction and laparoscopic BSO over a 7-year period (March 2010-February 2017) were identified. RESULTS: A total of 16 patients underwent PM with immediate reconstruction and concurrent BSO. The mean age at the time of surgery was 46.2 ± 6.6 years. Thirteen (81%) patients were carriers of the BRCA1 or BRCA2 mutation. Two patients had prophylactic surgical therapy for BRCA1 mutation and 14 (87.5%) patients had prior oncological treatment. The most common type of procedures performed were skin-sparing, nipple-sparing mastectomy (56.2%) and reconstruction with acellular dermal matrix and implants (43.8%). All patients underwent laparoscopic BSO. The average combined case time was 282.5 ± 81.3 minutes with an average postoperative hospital stay of 1.3 ± 0.5 days. Six (37.5%) patients presented with 30-day postoperative complications, with higher rates in the alloplastic group. There were no gynecological complications. CONCLUSIONS: In conclusion, our results demonstrate that a combined multidisciplinary surgical approach did not increase length of stay or 30-day complication rates. Furthermore, concurrent risk-reducing strategies are an effective option for patients at high risk of breast or ovarian cancer.
PURPOSE: There are limited data on coordinated breast and gynecological risk-reduction surgery for high-risk patients in Canada. Therefore, this study aims to evaluate the patient demographics, surgical details, and outcomes of prophylactic mastectomy (PM) with immediate reconstruction and bilateral salpingo-oophorectomy (BSO) in high-risk patients. METHODS: We conducted a retrospective chart review at an academic center of patients who concurrently underwent PM with immediate reconstruction and laparoscopic BSO over a 7-year period (March 2010-February 2017) were identified. RESULTS: A total of 16 patients underwent PM with immediate reconstruction and concurrent BSO. The mean age at the time of surgery was 46.2 ± 6.6 years. Thirteen (81%) patients were carriers of the BRCA1 or BRCA2 mutation. Two patients had prophylactic surgical therapy for BRCA1 mutation and 14 (87.5%) patients had prior oncological treatment. The most common type of procedures performed were skin-sparing, nipple-sparing mastectomy (56.2%) and reconstruction with acellular dermal matrix and implants (43.8%). All patients underwent laparoscopic BSO. The average combined case time was 282.5 ± 81.3 minutes with an average postoperative hospital stay of 1.3 ± 0.5 days. Six (37.5%) patients presented with 30-day postoperative complications, with higher rates in the alloplastic group. There were no gynecological complications. CONCLUSIONS: In conclusion, our results demonstrate that a combined multidisciplinary surgical approach did not increase length of stay or 30-day complication rates. Furthermore, concurrent risk-reducing strategies are an effective option for patients at high risk of breast or ovarian cancer.
Authors: W Burke; M Daly; J Garber; J Botkin; M J Kahn; P Lynch; A McTiernan; K Offit; J Perlman; G Petersen; E Thomson; C Varricchio Journal: JAMA Date: 1997-03-26 Impact factor: 56.272
Authors: Monica Morrow; Yun Li; Amy K Alderman; Reshma Jagsi; Ann S Hamilton; John J Graff; Sarah T Hawley; Steven J Katz Journal: JAMA Surg Date: 2014-10 Impact factor: 14.766
Authors: Susan M Domchek; Tara M Friebel; Christian F Singer; D Gareth Evans; Henry T Lynch; Claudine Isaacs; Judy E Garber; Susan L Neuhausen; Ellen Matloff; Rosalind Eeles; Gabriella Pichert; Laura Van t'veer; Nadine Tung; Jeffrey N Weitzel; Fergus J Couch; Wendy S Rubinstein; Patricia A Ganz; Mary B Daly; Olufunmilayo I Olopade; Gail Tomlinson; Joellen Schildkraut; Joanne L Blum; Timothy R Rebbeck Journal: JAMA Date: 2010-09-01 Impact factor: 56.272
Authors: Timothy R Rebbeck; Henry T Lynch; Susan L Neuhausen; Steven A Narod; Laura Van't Veer; Judy E Garber; Gareth Evans; Claudine Isaacs; Mary B Daly; Ellen Matloff; Olufunmilayo I Olopade; Barbara L Weber Journal: N Engl J Med Date: 2002-05-20 Impact factor: 91.245