Breast reconstruction in patients with BRCA mutation and breast cancer – our approach
Authors:
Ventruba T. 1,2; Brančíková D. 3; Ventruba P. 2; Minář L. 2; Felsinger M. 2; Vomela J. 2,4
Authors‘ workplace:
V-CLINIC, Klinika plastické, estetické chirurgie a gynekologie Brno
1; Gynekologicko-porodnická klinika LF MU a FN Brno
2; Interní hematologická a onkologická klinika LF MU a FN Brno
3; Chirurgická klinika LF MU a FN Brno
4
Published in:
Ceska Gynekol 2021; 86(6): 374-380
Category:
Original Article
doi:
https://doi.org/10.48095/cccg2021374
Overview
Objective: Analysis of our approach to breast reconstruction after mastectomy in women with breast cancer and/or BRCA mutations. Oncoplastic surgery enables procedures that are sufficiently radical and with a very good cosmetic effect. With the development of genetic testing programs, the need for prophylactic procedures is also increasing. One-sided curative performance and at the same time prophylactic surgery on the other breast can be used. Methods: We use the possibility of immediate breast reconstruction simultaneously with subcutaneous and skin-saving mastectomy. We solve the reconstruction either with an expander and in the second time by inserting a silicone implant, or directly by inserting the implant alone or in combination with the use of autologous tissue, depending on further oncological treatment (chemotherapy or radiotherapy). Results: One-hundred and three reconstructive surgeries were performed on 58 women with breast cancer and/or BRCA mutations from April 2017 to May 2020. Of these, there were 52 immediate reconstructions for untreated tumors. A tissue expander was inserted in 27 women (46.6% of the group) with locally advanced tumors and the need for subsequent radiotherapy (18 immediate and 9 delayed reconstructions). Breast implants were used in 52 women (89.7% of the group) in a total of 80 implants. Breast reconstruction of own tissues was performed in 8 women, of which 5 operations had immediate reconstruction. Postoperative complications occurred in 11 women and 15 corrective procedures were performed (12.7% of operations). Conclusion: Breast reconstruction is a comprehensive set of techniques by which any patient can obtain a breast so that it does not depend on the epithelium. Patients with locally advanced disease who receive neoadjuvant chemotherapy and radiotherapy are at greater risk of complications. With the growing number of breast cancers, the demand for reconstructive procedures, especially immediate reconstructions, is increasing.
Keywords:
breast cancer – Mastectomy – BRCA mutations – breast implants – expander – immediate breast reconstruction – delayed reconstruction – tissue lobe
Sources
1. Ballard TN, Zhong L, Momoh AO et al. Improved rates of immediate breast reconstruction at safety net hospitals. Plast Reconstr Surg 2017; 140 (1): 1–10. doi: 10.1097/PRS.0000000 000003412.
2. Biglia N, D‘Alonzo M, Sgro LG et al. Breast cancer treatment in mutation carriers: surgical treatment. Minerva Ginecol 2016; 68 (5): 548–556.
3. Coufal O, Gabrielová L, Justan I et al. Spokojenost onkologických pacientek s okamžitou dvoudobou aloplastickou rekonstrukcí prsu. Klin Onkol 2014; 27 (5): 353–360. doi: 10.14735/amko2014353.
4. Schmidt JL, Wetzel CM, Lange KW et al. Patients‘ experience of breast reconstruction after mastectomy and its influence on postoperative satisfaction. Arch Gynecol Obstet 2017; 296 (4): 827–834. doi: 10.1007/s00404-017-4495-5.
5. Dražan L, Veselý J, Hýža P et al. Chirurgická prevence karcinomu prsu pacientek s dědičným rizikem. Klin Onkol 2012; 25 (Suppl): S78–S83.
6. Vallard A, Magné N, Guy JB et al. Is breast-conserving therapy adequate in BRCA 1/2 mutation carriers? The radiation oncologist’s point of view. Br J Radiol 2019; 92 (1097): 20170657. doi: 10.1259/bjr.20170657.
7. Valachis A, Nearchou AD, Lind P. Surgical management of breast cancer in BRCA-mutation carriers: a systematic review and meta-analysis. Breast Cancer Res Treat 2014; 144 (3): 443–455. doi: 10.1007/s10549-014-2890-1.
8. Yamamoto D, Tanaka Y, Tsubota Y et al. Immediate breast reconstruction for breast cancer. Gan To Kagaku Ryoho 2014; 41 (12): 1892–1894.
9. Zikán M. Gynekologická prevence a gynekologické aspekty péče u nosiček mutací genů BRCA1 a BRCA2. Klin Onkol 2016; 29 (Suppl 1): S22–S30. doi: 10.14735/amko2016s22.
10. Nagura N, Hayashi N, Takei J et al. Breast reconstruction after risk-reducing mastectomy in BRCA mutation carriers. Breast Cancer 2020; 27 (1): 70–76. doi: 10.1007/s12282-019-00995-y.
11. Ye JM, Xin L, Wang Y et al. Breast reconstruction after mastectomy in breast cancer patients: specialization and standardization. Zhonghua Wai Ke Za Zhi 2019; 57 (2): 88–91. doi: 10.3760/cma.j.issn.0529-5815.2019.02.003.
12. Cabañuz MA, Del Amo MD, Romea IG et al. Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: a safe option? Cir Esp (Engl Ed) 2019; 97 (10): 575–581. doi: 10.1016/j.ciresp.2019.07.003.
13. Rocco N, Catanuto G, Nava MB. Radiotherapy and breast reconstruction. Minerva Chir 2018; 73 (3): 322–328. doi: 10.23736/S0026- 4733.18.07615-0.
14. Yun JH, Diaz R, Orman AG. Breast reconstruction and radiation therapy. Cancer Control 2018; 25 (1): 1073274818795489. doi: 10.1177/ 1073274818795489.
15. Billig J, Jagsi R, Qi J et al. Should immediate autologous breast reconstruction be considered in women who require postmastectomy radiation therapy? A prospective analysis of outcomes. Plast Reconstr Surg 2017; 139 (6): 1279–1288. doi: 10.1097/PRS.0000000000003331.
16. Coufal O, Gabrielová L, Justan I et al. Spokojenost onkologických pacientek s okamžitou dvoudobou aloplastickou rekonstrukcí prsu. Klin Onkol 2014; 27 (5): 353–360. doi: 10.14735/amko2014353.
17. Ventruba T, Brančíková D, Minář L et al. Rekonstrukce prsou u pacientek s BRCA mutací a karcinomem prsu – náš přístup. In: Sborník abstrakt 30. sympozia asistované reprodukce SAR ČGPS ČLS JEP a 19. česko–slovenské konference reprodukční gynekologie, Brno 2020: 12–13.
18. Farhangkhoee H, Matros E, Disa J. Trends and concepts in post-mastectomy breast reconstruction. J Surg Oncol 2016; 113 (8): 891–894. doi: 10.1002/jso.24201.
19. Jeevan R. Reconstructive utilisation and outcomes following mastectomy surgery in women with breast cancer treated in England. Ann R Coll Surg Engl 2020; 102 (2): 110–114. doi: 10.1308/rcsann.2019.0101.
20. Hamann M, Brunnbauer M, Scheithauer H et al. Quality of life in breast cancer patients and surgical results of immediate tissue expander/implant-based breast reconstruction after mastectomy. Arch Gynecol Obstet 2019; 300 (2): 409–420. doi: 10.1007/s00404-019-05 201-0.
21. Co M, Liu T, Leung J et al. Breast conserving surgery for BRCA mutation carriers – a systematic review. Clin Breast Cancer 2020; 20 (3): e244–e250. doi: 10.1016/j.clbc.2019.07.014.
22. Cronin PA, Cody HS. Surgical management of breast cancer in BRCA mutation carriers. In: Chagpar AB (eds). Managing BRCA mutation carriers. Springer 2017: 119–134.
23. Kolářová H. Péče o nosičky mutací genů BRCA1 a BRCA2 z hlediska onkogynekologa. Onkologie 2017; 11 (5): 228–230. doi: 10.36290/xon. 2017.043.
24. Davey MG, Davey CM, Ryan ÉJ et al. Combined breast conservation therapy versus mastectomy for BRCA mutation carriers – a systematic review and meta-analysis. Breast 2021; 56: 26–34. doi: 10.1016/j.breast.2021.02.001.
25. Kauff ND, Domchek SM, Friebel TM et al. Risk-reducing salpingo-oophorectomy for the prevention of BRCA1 and BRCA2 associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol 2008; 26 (8): 1331–1337. doi: 10.1200/JCO.2007.13. 9626.
26. Ho AY, Hu ZI, Mehrara BJ et al. Radiotherapy in the setting of breast reconstruction: types, techniques, and timing. Lancet Oncol 2017; 18 (12): e742–e753. doi: 10.1016/S1470- 2045 (17) 30617-4.
27. Ventruba T, Ventruba P, Brančíková D et al. Onkoplastická chirurgie karcinomu prsu – využití okamžité rekonstrukce: 2016–2020. In: Sborník abstrakt 7. kongres ČGPS ČLS JEP a SGPS SLS, 16.–19. 9. 2021, Karlovy Vary: 47.
28. Ventrubová G. Rekonstrukce prsou z pohledu pacientek. Diplomová práce. Ústav Dr. P. Blahu, Skalica, Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety. Slovenská republika: Bratislava 2019.
29. Jones LP, Sampson A, Kang HJ et al. Loss of BRCA1 leads to an increased sensitivity to Bisphenol A. Toxicol Lett 2010; 199 (3): 261–268. doi: 10.1016/j.toxlet.2010.09.008.
30. Ješeta M, Moravec J, Žáková J et al. Bisphenol S content in human follicular fluid and its effect on IVF outcomes. Hum Reprod 2019; 34 (Supp 1): i240.
31. Ješeta M, Navrátilová J, Kalina J et al. Presence of Bisphenol A in seminal plasma is associated with lower semen parameters, especially in men with varicoccele. Fertil Steril 2021; 116 (3), ASRM e345. doi: 10.1016/j.fertnstert.2021.07. 926.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2021 Issue 6
Most read in this issue
- Comparison of dinoprostone, misoprostol and amniotomy in labor induction
- The role of the microbiome in pregnancy
- Covid-19 as a possible risk factor of intrauterine fetal death
- Breast reconstruction in patients with BRCA mutation and breast cancer – our approach