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

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.

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Fig. 1

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

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Acknowledgements

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

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Correspondence to Akiyo Yoshimura.

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The authors have no conflicts of interest to declare.

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Yoshimura, A., Okumura, S., Sawaki, M. et al. Feasibility study of contralateral risk-reducing mastectomy with breast reconstruction for breast cancer patients with BRCA mutations in Japan. Breast Cancer 25, 539–546 (2018). https://doi.org/10.1007/s12282-018-0850-z

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Keywords

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