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Breast Cancer

, Volume 25, Issue 5, pp 539–546 | Cite as

Feasibility study of contralateral risk-reducing mastectomy with breast reconstruction for breast cancer patients with BRCA mutations in Japan

  • Akiyo Yoshimura
  • Seiko Okumura
  • Masataka Sawaki
  • Masaya Hattori
  • Junko Ishiguro
  • Yayoi Adachi
  • Haruru Kotani
  • Naomi Gondo
  • Ayumi Kataoka
  • Madoka Iwase
  • Sakura Onishi
  • Kayoko Sugino
  • Mitsuo Terada
  • Nanae Horisawa
  • Makiko Mori
  • Nobue Takaiso
  • Ikuo Hyodo
  • Hiroji Iwata
Original Article
  • 213 Downloads

Abstract

Background

Contralateral risk-reducing mastectomy (CRRM) for breast cancer patients with BRCA mutations has been reported to not only reduce breast cancer incidence but also to improve survival. The National Comprehensive Cancer Network guidelines recommend providing CRRM to women with BRCA mutations who desire CRRM after risk-reduction counseling. However, in Japan, CRRM cannot be performed generally because it is not covered by health insurance. Thus, we conducted a feasibility study to confirm the safety of CRRM.

Methods

CRRM with bilateral breast reconstructions were performed for breast cancer patients with BRCA mutations. The primary endpoint was early adverse events within 3 months, and secondary endpoints were late adverse events.

Results

Between August 2014 and November 2016, ten patients were enrolled. The median age was 37.5 years, and five of the patients had the BRCA1 mutation while five had the BRCA2 mutation. Six patients received neoadjuvant chemotherapy. Eight patients selected silicone breast implants, and two patients selected transverse rectus abdominis myocutaneous flap reconstruction. Pathological findings showed no evidence of occult breast cancers in any of the patients. At a median of 25.5 months follow-up time, CRRM-related early adverse events were hematoma (subsequently removed by re-operation; grade 2, n = 1), wound infection (grade 2, n = 1), skin ulceration (grade 1, n = 2) and wound pain (grade 1, n = 1). Overall, there were no grade 3 or more severe adverse events.

Conclusion

Our results confirm that CRRM with reconstruction could be performed safely.

Keywords

Hereditary breast and ovarian cancer Risk reduction mastectomy BRCA mutation Breast reconstruction 

Abbreviations

SBI

Silicone breast implant

LD

Latissimus dorsi muscle transfer flap

TRAM

Transverse rectus abdominis myocutaneous flap

TE

Tissue expander

CRRM

Contralateral risk-reducing mastectomy

RRSO

Risk-reducing salpingo-oophorectomy

Bt

Total mastectomy

SSM

Skin sparing mastectomy

NSM

Nipple sparing mastectomy

SLNB

Sentinel lymph node biopsy

Ax

Axillary lymph node dissection

Notes

Acknowledgements

We thank all the patients and investigators who participated in this study.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

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Copyright information

© The Japanese Breast Cancer Society 2018

Authors and Affiliations

  • Akiyo Yoshimura
    • 1
  • Seiko Okumura
    • 2
  • Masataka Sawaki
    • 1
  • Masaya Hattori
    • 1
  • Junko Ishiguro
    • 3
  • Yayoi Adachi
    • 1
  • Haruru Kotani
    • 1
  • Naomi Gondo
    • 1
  • Ayumi Kataoka
    • 1
  • Madoka Iwase
    • 1
  • Sakura Onishi
    • 1
  • Kayoko Sugino
    • 1
  • Mitsuo Terada
    • 1
  • Nanae Horisawa
    • 1
  • Makiko Mori
    • 1
  • Nobue Takaiso
    • 1
  • Ikuo Hyodo
    • 2
  • Hiroji Iwata
    • 1
  1. 1.Department of Breast OncologyAichi Cancer HospitalNagoyaJapan
  2. 2.Department of Plastic and Reconstructive SurgeryAichi Cancer HospitalNagoyaJapan
  3. 3.Division of Molecular MedicineAichi Cancer Center Research InstituteNagoyaJapan

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