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Prophylactic mastectomy with immediate reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via a transmammary route: a novel surgical approach to female BRCA-mutation carriers

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

Breast reconstruction with salpingo-oophorectomy can easily be performed in patients with genetic mutations increasing the risk for mammary and ovarian carcinoma. However, many patients are skeptical about having several surgeries, as they may result in additional anesthesiological risks as well as multiple visible scars. Therefore, the purpose of this study was to evaluate the feasibility of prophylactic mastectomy and breast reconstruction combined with simultaneous transmammary salpingo-oophorectomy for BRCA carriers.

Materials and methods

Of the six patients (1 %) who chose prophylactic mastectomy with salpingo-oophorectomy at our hospital four patients had BRCA-1 mutations, one patient had a BRCA-2 mutation and one patient had a family inheritance pattern with no mutations. All patients chose to reduce their risk for mammary and ovarian cancer by undergoing bilateral mastectomy and bilateral salpingo-oophorectomy. Prophylactic mastectomy with immediate reconstruction was performed, followed by bilateral salpingo-oophorectomy with a procedure that relies on transmammary access and reduces the number of necessary surgeries without compromising cosmetic results, surgical risks and operating time.

Result

The mean age of the patients was 46.7 ± 1.8 years (SD). The mean operative time was 190.2 ± 13.7 min. No complications were observed during the operations. The mean intra-operative loss of blood was 363.3 ± 77.9 ml. The operative method was successful in all six cases and was performed with no complications. All of the patients were satisfied with the cosmetic results.

Conclusion

In conclusion, prophylactic mastectomy and breast reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via transmammary access is feasible, easy to perform and provides an intriguing and novel approach to female BRCA carriers who desire operative prophylactic measures in one surgical session with no visible abdominal scars and no additional risks and complications.

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References

  1. Brenner H, Stegmaier C, Ziegler H (2005) Long-term survival of cancer patients in Germany achieved by the beginning of the third millenium. Ann Oncol 16(6):981–986. doi:10.1093/annonc/mdi186

    Article  CAS  PubMed  Google Scholar 

  2. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58(2):71–96. doi:10.3322/CA.2007.0010

    Article  PubMed  Google Scholar 

  3. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62(1):10–29. doi:10.3322/caac.20138

    Article  PubMed  Google Scholar 

  4. Antoniou AC, Pharoah PD, Narod S, Risch HA, Eyfjord JE, Hopper JL, Olsson H, Johannsson O, Borg A, Pasini B, Radice P, Manoukian S, Eccles DM, Tang N, Olah E, Anton-Culver H, Warner E, Lubinski J, Gronwald J, Gorski B, Tulinius H, Thorlacius S, Eerola H, Nevanlinna H, Syrjakoski K, Kallioniemi OP, Thompson D, Evans C, Peto J, Lalloo F, Evans DG, Easton DF (2005) Breast and ovarian cancer risks to carriers of the BRCA1 5382insC and 185delAG and BRCA2 6174delT mutations: a combined analysis of 22 population based studies. J Med Genet 42(7):602–603. doi:10.1136/jmg.2004.024133

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Lalloo F, Varley J, Moran A, Ellis D, O’Dair L, Pharoah P, Antoniou A, Hartley R, Shenton A, Seal S, Bulman B, Howell A, Evans DG (2006) BRCA1, BRCA2 and TP53 mutations in very early-onset breast cancer with associated risks to relatives. Eur J Cancer 42(8):1143–1150. doi:10.1016/j.ejca.2005.11.032

    Article  CAS  PubMed  Google Scholar 

  6. Levy-Lahad E, Friedman E (2007) Cancer risks among BRCA1 and BRCA2 mutation carriers. Br J Cancer 96(1):11–15. doi:10.1038/sj.bjc.6603535

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Dian D, Schwenn K, Mylonas I, Janni W, Jaenicke F, Friese K (2007) Aesthetic result among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy. Arch Gynecol Obstet 275(6):445–450. doi:10.1007/s00404-006-0270-8

    Article  PubMed  Google Scholar 

  8. Salzberg CA, Dunavant C, Nocera N (2012) Immediate breast reconstruction using porcine acellular dermal matrix (Strattice): long-term outcomes and complications. J Plast Reconstr Aesthet Surg. doi:10.1016/j.bjps.2012.10.015

    PubMed  Google Scholar 

  9. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142(9):823–826. doi:10.1001/archsurg.142.9.823 (discussion 826–827)

    Article  PubMed  Google Scholar 

  10. Swanstrom LL (2007) Beyond endoluminal therapeutic endoscopy. Gastrointest Endosc 66(1):121–122. doi:10.1016/j.gie.2006.12.006

    Article  PubMed  Google Scholar 

  11. Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 61(3):449–453

    Article  PubMed  Google Scholar 

  12. Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60(1):114–117

    Article  PubMed  Google Scholar 

  13. Wagh MS, Merrifield BF, Thompson CC (2005) Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 3(9):892–896

    Article  PubMed  Google Scholar 

  14. Dian D, Rack B, Drinovac V, Mylonas I, Janni W, Friese K (2008) First experiences worldwide with NOTES in gynaecology. Geburtshilfe Frauenheilkd 68(9):930–933. doi:10.1055/s-2008-1038779

    Article  Google Scholar 

  15. Wallwiener D, Hirsch HA, Käser O, Iklé FA (2009) Atlas der gynäkologischen Operationen. 7, vollst. überarb. und erw. Aufl. edn. Thieme, Stuttgart

  16. Toth BA, Lappert P (1991) Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg 87(6):1048–1053

    Article  CAS  PubMed  Google Scholar 

  17. Kroll SS, Khoo A, Singletary SE, Ames FC, Wang BG, Reece GP, Miller MJ, Evans GR, Robb GL (1999) Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Plast Reconstr Surg 104(2):421–425

    Article  CAS  PubMed  Google Scholar 

  18. Slavin SA, Schnitt SJ, Duda RB, Houlihan MJ, Koufman CN, Morris DJ, Troyan SL, Goldwyn RM (1998) Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 102(1):49–62

    Article  CAS  PubMed  Google Scholar 

  19. Rivadeneira DE, Simmons RM, Fish SK, Gayle L, La Trenta GS, Swistel A, Osborne MP (2000) Skin-sparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence. Cancer J 6(5):331–335

    CAS  PubMed  Google Scholar 

  20. Medina-Franco H, Vasconez LO, Fix RJ, Heslin MJ, Beenken SW, Bland KI, Urist MM (2002) Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann Surg 235(6):814–819

    Article  PubMed Central  PubMed  Google Scholar 

  21. Carlson GW, Bostwick J 3rd, Styblo TM, Moore B, Bried JT, Murray, Wood WC (1997) Skin-sparing mastectomy. Oncologic and reconstructive considerations. Ann Surg 225(5):570–575 (discussion 575–578)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Skoll PJ, Hudson DA (2002) Skin-sparing mastectomy using a modified wise pattern. Plast Reconstr Surg 110(1):214–217

    Article  PubMed  Google Scholar 

  23. Hammond DC, Capraro PA, Ozolins EB, Arnold JF (2002) Use of a skin-sparing reduction pattern to create a combination skin-muscle flap pocket in immediate breast reconstruction. Plast Reconstr Surg 110(1):206–211

    Article  PubMed  Google Scholar 

  24. Nava MB, Cortinovis U, Ottolenghi J, Riggio E, Pennati A, Catanuto G, Greco M, Rovere GQ (2006) Skin-reducing mastectomy. Plast Reconstr Surg 118(3):603–610. doi:10.1097/01.prs.0000233024.08392.14 (discussion 611–603)

    Article  CAS  PubMed  Google Scholar 

  25. Breuing KH, Warren SM (2005) Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg 55(3):232–239. doi:http://journals.lww.com/annalsplasticsurgery/Abstract/2005/09000/Immediate_Bilateral_Breast_Reconstruction_With.2.aspx

    Article  CAS  PubMed  Google Scholar 

  26. Breuing KH, Colwell AS (2007) Inferolateral AlloDerm hammock for implant coverage in breast reconstruction. Ann Plast Surg 59(3):250–255. doi:10.1097/SAP.0b013e31802f8426

    Article  CAS  PubMed  Google Scholar 

  27. Zienowicz RJ, Karacaoglu E (2007) Implant-based breast reconstruction with allograft. Plast Reconstr Surg 120(2):373–381. doi:10.1097/01.prs.0000267340.31742.1

    Article  CAS  PubMed  Google Scholar 

  28. Rolanda C, Lima E, Pego JM, Henriques-Coelho T, Silva D, Moreira I, Macedo G, Carvalho JL, Correia-Pinto J (2007) Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video). Gastrointest Endosc 65(1):111–117. doi:10.1016/j.gie.2006.07.050

    Article  PubMed  Google Scholar 

  29. Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC (2006) Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc 64(3):428–434. doi:10.1016/j.gie.2006.06.079

    Article  PubMed  Google Scholar 

  30. Lima E, Rolanda C, Correia-Pinto J (2008) Transvesical endoscopic peritoneoscopy: intra-abdominal scarless surgery for urologic applications. Curr Urol Rep 9(1):50–54

    Article  PubMed  Google Scholar 

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Conflict of interst

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. 1st Department of Obstetrics and Gynecology, Campus Innenstadt, Ludwig-Maximilians-University Munich, Maistrasse 11, 80337, Munich, Germany

    Marta Perabò, Visnja Fink, Maria Günthner-Biller, Vera von Bodungen, Klaus Friese & Darius Dian

  2. Department of Obstetrics and Gynecology, Campus Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany

    Visnja Fink & Klaus Friese

Authors
  1. Marta Perabò
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  2. Visnja Fink
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  3. Maria Günthner-Biller
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  4. Vera von Bodungen
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  6. Darius Dian
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Correspondence to Darius Dian.

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M. Perabò and V. Fink contributed equally to this manuscript.

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Perabò, M., Fink, V., Günthner-Biller, M. et al. Prophylactic mastectomy with immediate reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via a transmammary route: a novel surgical approach to female BRCA-mutation carriers. Arch Gynecol Obstet 289, 1325–1330 (2014). https://doi.org/10.1007/s00404-013-3133-0

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  • DOI: https://doi.org/10.1007/s00404-013-3133-0

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