Breast Cancer

, Volume 27, Issue 1, pp 70–76 | Cite as

Breast reconstruction after risk-reducing mastectomy in BRCA mutation carriers

  • Naomi Nagura
  • Naoki Hayashi
  • Junko Takei
  • Atsushi Yoshida
  • Tomohiro Ochi
  • Yoshiko Iwahira
  • Hideko YamauchiEmail author
Original Article



Breast reconstruction is a favorable option for women with BRCA1 or BRCA2 mutations (BRCA1/2Mut+) who undergo risk-reducing mastectomy (RRM). We assessed characteristics of patients who underwent RRM, with or without breast reconstruction.


We included 46 patients with BRCA1/2Mut+ who underwent RRM from July 2011 to December 2017.


Among the 46 patients who underwent RRM, 3 had not been diagnosed with breast cancer (BC) and 43 had cancer in a single breast; 33 patients (71.7%) underwent breast reconstruction with RRM; and 13 patients (28.3%) did not undergo breast reconstruction. All of 3 patients who had not been diagnosed with BC underwent bilateral RRM with breast reconstruction. There was no significant difference of clinical characteristic between patients undergoing RRM with and without breast reconstruction. However, patients who decided to undergo RRM with the current diagnosis of BC had significantly higher rates of RRM with breast reconstruction than that of patients with a past history of BC (P = 0.043). The rate of nipple-sparing mastectomy (NSM) in patients with breast reconstruction was significantly higher (28 of the 37 breasts, 75.7%) than that in patients without reconstruction (3 of the 14 breasts, 21.4%) (P < 0.001). Two patients who had complications underwent RRM with breast reconstruction, and one of them had a history of irradiation after lumpectomy.


For BRCA1/2Mut+ patients, the decision of taking RRM with the diagnosis of current BC might affect whether they undergo immediate breast reconstruction with RRM. These patients who undergo RRM with breast reconstruction preferred NSM to skin-sparing mastectomies.


BRCA mutation carriers Risk-reducing mastectomy Breast cancer Breast reconstruction 



We would like to express our gratitude to all the colleagues and staff at St. Luke’s International Hospital and the Breast Surgery Clinic.


Funding has been received from Health, Labour and Welfare in Japan with Grand No. Health, Labour and Welfare Sciences Research Grants (H29-policy for cancer-general-003) and (18cm0106503h0003). The fee for the risk reduction procedure was paid by the patient own.


  1. 1.
    Chen S, Parmigiani G. Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol. 2007;25(11):1329–33.CrossRefGoogle Scholar
  2. 2.
    Domchek SM, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304(9):967–75.CrossRefGoogle Scholar
  3. 3.
    Rebbeck TR, Friebel T, Lynch HT, Neuhausen SL, van Veer L, Garber JE, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2004;22(6):1055–62.CrossRefGoogle Scholar
  4. 4.
    Meijers-Heijboer H, van Geel B, van Putten WL, Henzen-Logmans SC, Seynaeve C, Menke-Pluymers MB, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345(3):159–64.CrossRefGoogle Scholar
  5. 5.
    Yamauchi H, Takei J. Management of hereditary breast and ovarian cancer. Int J Clin Oncol. 2018;23(1):45–51.CrossRefGoogle Scholar
  6. 6.
    Heemskerk-Gerritsen BA, Rookus MA, Aalfs CM, Ausems MG, Collee JM, Jansen L, Kets CM, et al. Improved overall survival after contralateral risk-reducing mastectomy in BRCA1/2 mutation carriers with a history of unilateral breast cancer: a prospective analysis. Int J Cancer. 2015;136(3):668–77.PubMedGoogle Scholar
  7. 7.
    Metcalfe K, Gershman S, Ghadirian P, Lynch HT, Snyder C, Tung N, et al. Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis. BMJ. 2014;348:g226.CrossRefGoogle Scholar
  8. 8.
    Evans DG, Ingham SL, Baildam A, Ross GL, Lalloo F, Buchan I, et al. Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer. Breast Cancer Res Treat. 2013;140(1):135–42.CrossRefGoogle Scholar
  9. 9.
    Hoskin TL, Hieken TJ, Degnim AC, Jakub JW, Jacobson SR, Boughey JC. Use of immediate breast reconstruction and choice for contralateral prophylactic mastectomy. Surgery. 2016;159(4):1199–209.CrossRefGoogle Scholar
  10. 10.
    Semple J, Metcalfe KA, Lynch HT, Kim-Sing C, Senter L, Pal T, et al. International rates of breast reconstruction after prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers. Ann Surg Oncol. 2013;20(12):3817–22.CrossRefGoogle Scholar
  11. 11.
    Hallam S, Govindarajulu S, Huckett B, Bahl A. BRCA1/2 Mutation-associated Breast cancer, wide local excision and radiotherapy or unilateral mastectomy: a systematic review. Clin Oncol (R Coll Radiol). 2015;27(9):527–35.CrossRefGoogle Scholar
  12. 12.
    Buchanan PJ, Abdulghani M, Waljee JF, Kozlow JH, Sabel MS, Newman LA, et al. An Analysis of the decisions made for contralateral prophylactic mastectomy and breast reconstruction. Plast Reconstr Surg. 2016;138(1):29–40.CrossRefGoogle Scholar
  13. 13.
    Nurudeen S, Guo H, Chun Y, Coopey S, Barry W, Garber J, et al. Patient experience with breast reconstruction process following bilateral mastectomy in BRCA mutation carriers. Am J Surg. 2017;214(4):687–94.CrossRefGoogle Scholar
  14. 14.
    Metcalfe KA, Cil TD, Semple JL, Li LD, Bagher S, Zhong T, et al. Long-Term psychosocial functioning in women with bilateral prophylactic mastectomy: does preservation of the nipple-areolar complex make a difference? Ann Surg Oncol. 2015;22(10):3324–30.CrossRefGoogle Scholar
  15. 15.
    Yamauchi H, Okawa M, Yokoyama S, Nakagawa C, Yoshida R, Suzuki K, et al. High rate of occult cancer found in prophylactic mastectomy specimens despite thorough presurgical assessment with MRI and ultrasound: findings from the Hereditary Breast and Ovarian Cancer Registration 2016 in Japan. Breast Cancer Res Treat. 2018;172(3):679–87.CrossRefGoogle Scholar
  16. 16.
    Manning AT, Wood C, Eaton A, Stempel M, Capko D, Pusic A, Morrow M, et al. Nipple-sparing mastectomy in patients with BRCA1/2 mutations and variants of uncertain significance. Br J Surg. 2015;102(11):1354–9.CrossRefGoogle Scholar
  17. 17.
    Hirsch EM, Seth AK, Dumanian GA, Kim JY, Mustoe TA, Galiano RD, et al. Outcomes of tissue expander/implant breast reconstruction in the setting of prereconstruction radiation. Plast Reconstr Surg. 2012;129(2):354–61.CrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2019

Authors and Affiliations

  1. 1.Department of Breast Surgical OncologySt. Luke’S International HospitalTokyoJapan
  2. 2.Breast Surgery Clinic, YCC Takanawa Bild.TokyoJapan

Personalised recommendations