Skip to main content

Advertisement

Log in

Subcutaneous mastectomy and immediate reconstruction for prevention of breast cancer for high-risk patients

  • Conference Paper
  • Invited Lecture
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Breast cancer is the most common malignant tumor among females in the USA, with one out of eight American females developing breast cancer in their lifetimes. The latest studies [1] show that 212,920 new cases of invasive cancer developed in 2006, which is 2.5 times more common than the incidence of lung cancer, and that 40,970 females will die from this disease each year. Therefore, awareness of this cancer is an important health issue, with more women beginning to assess their risk of breast cancer, either informally or with instruments such as the GAIL model [2]. The availability of genetic testing for BRCA-1 and BRCA-2 has revealed many women who are at significantly increased risk. Many aggressive surveillance programs have been developed using advanced MRI and ultrasound, and reductions in breast cancer risk of 50% or more have been proven using chemoprevention strategies with tamoxifen and raloxifene. However, many women are starting to seriously consider prophylactic mastectomy for near-total reduction of breast cancer risk. At our institution, we have developed a procedure for prophylactic subcutaneous mastectomy via an inframammary incision that spares the nipple and is combined with immediate silicone implant reconstruction with the assistance of Alloderm®. In this article we will describe the procedure and some of the important issues surrounding its implementation from our experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17

Similar content being viewed by others

References

  1. Ahmedin J, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ. Cancer statistics. Cancer J Clin. 2006; 56:106–30.

    Article  Google Scholar 

  2. Gail Model Health Assessment, Brinton LA, Byar DP, Corle DK, Green SB, Schiner C, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81:1879–86.

    Article  PubMed  Google Scholar 

  3. Fisher B, Constantino JP, Wickerman DL, et al. Tamoxifen for prevention of breast caner. Report of the National Surgical Adjunct Breast and Bowel Poject P-1 Study. J Natl Cancer Inst. 1989;90:137–8.

    Google Scholar 

  4. Frank TS, Deffenbaugh AM, et al. Clinical Characteristics of individuals with germline mutation in BRCA 1 and BRCA 2, analysis of 10, 000 individuals. J Clin Oncol. 2002;20(6):1480–90.

    Article  PubMed  CAS  Google Scholar 

  5. Hartman LC, Schnaid D, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New Engl J Med. 1999;340(2):77–84.

    Article  Google Scholar 

  6. McDonnell SK, Schaid DJ, Myers FJ, et al. Efficacy of contralateral prophylactic mastectomy in women with personal and family history of breast cancer. J Clin Oncol. 2001;19(19):3938–43.

    PubMed  CAS  Google Scholar 

  7. Van Geel AN. Prophylactic mastectomy: The Rotterdam experience. Breast. 2003;12(6):357–61.

    Article  PubMed  Google Scholar 

  8. Vogel VG, Constantino JP, Wickerman DL, Cronin WM, et al. Effects of tamoxifen vs. raloxifen on the risk of developing invasive breast cancer and other disease outcomes. NSABP study of tamoxifen and raloxifen (STAR) P-2 trial. J Am Med Assoc. 2006;295(23):2727–41.

    Article  CAS  Google Scholar 

  9. Schrag D, Kuntz KM, Garber JE, Week JC. Decision analysis—effects of prophylactic mastectomy and oophorectomy on life expectancy among women in BRCA 1 or BRCA 2 mutation. New Engl J Med. 1997;336(20):1465–71.

    Article  PubMed  CAS  Google Scholar 

  10. Gramm VT, Panageas KS, et al. Decision analysis of prophylactic mastectomy and oophorectomy in BRCA 1 and BRCA 2 positive patients. J Clin Onco. 1988;16(3):979–85.

    Google Scholar 

  11. Meijers-Heijbour H, Van Geel B, Vanputten WL, Henzer-Hogan SC, Seymaeve C, Menke-Plymers MB, et al. Breast cancer after prophylactic bilateral mastectomy in women with BRCA 1 or BRCA 2 mutation. New Engl J Med. 2001;345(3):159–64.

    Article  Google Scholar 

  12. Constant CM, Menke-Pluijmers MB, Seymaeve C, Meijers-Heijbours EJ, Klijn JG, Verhoog LC, et al. Clinical experience of prophylactic mastectomy followed by immediate breast reconstruction in women of hereditary risk of breast cancer (HB(o) C) or proven BRCA 1 and BRCA 2 germline mutation. Euro J Surg Oncol. 2002;28(6):627–32.

    Article  Google Scholar 

  13. Freeman BS. Subcutaneous mastectomy for benign breast lesions with immediate or delayed prosthetic replacement. Plastic Reconst Surg. 1962;30:676–82.

    Article  CAS  Google Scholar 

  14. Pennisi VR, Capozzi AC. Subcutaneous mastectomy—an interim report on 1, 244 patients. Am Plastic Surg. 1984;12(4):340–7.

    Article  CAS  Google Scholar 

  15. Metcalfe KA, Esplen ML, Goel V, Narod SA. Predictors of qulaity of life in women with bilateral prophylactic mastectomy. Breast. 2005;11(1);65–9.

    Article  Google Scholar 

  16. Salzberg CA. Nonexpansive immediate breast reconstrcution using human acellular tissue matrix graft (Alloderm). Am Plastic Surg. 2006;7(1):1–5.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew Y. Ashikari.

Additional information

This article is based on an invited lecture delivered at the 15th Annual Meeting of the Japanese Breast Cancer Society, held in Yokohama 29–30 June 2007.

About this article

Cite this article

Ashikari, R.H., Ashikari, A.Y., Kelemen, P.R. et al. Subcutaneous mastectomy and immediate reconstruction for prevention of breast cancer for high-risk patients. Breast Cancer 15, 185–191 (2008). https://doi.org/10.1007/s12282-008-0059-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-008-0059-7

Keywords

Navigation