BRCA mutation carriers undergoing combined mastectomy with immediate reconstruction and gynecologic risk-reducing surgery: An analysis of outcomes.

Abstract

e13004 Background: The aim of this study was to assess outcomes of a multidisciplinary model for combined prophylactic and/or therapeutic mastectomy with immediate reconstruction and gynecologic risk-reducing surgery in patients with hereditary breast cancer syndromes. Methods: Between 2012 and 2016, 12 patients with documented BRCA1 and BRCA2 mutations underwent combined surgery at our facility. Procedures included bilateral mastectomy, axillary lymph node staging, immediate expander based reconstruction and minimally invasive salpingo-oophorectomy with added hysterectomy when indicated. All procedures were performed in a single operating room setting by rotating subspecialty teams. Results: Patient characteristics included a mean (+SD) BMI of 32.1±6.7 (23-44) kg/m2 and ASA of 2.2±0.4 (2-3). Fifty-eight percent (7/12) were premenopausal. Patient’s average age was 45.8+10.8 (30-73). Therapeutic mastectomy for breast cancer was performed in 4/12 patients. Of the 4 affected patients 2 had neo-adjuvant chemotherapy for locally advanced cancer. The remaining 8/12 had prophylactic mastectomies. Risk-reducing salpingo-oophorectomy was performed in 12/12 patients. Seventy-five percent (9/12) underwent concurrent minimally invasive hysterectomy for suspected gynecologic malignancy, leiomyoma, complex endometrial hyperplasia, dysmenorrhea and menorrhagia. Two gynecologic specimens required mini-laparotomy for removal. Mean total operative time was 283.3±66.5 (206-447) minutes and estimated blood loss (EBL) was 209.2±139.2 (50-500) ml. Hospital length of stay (LOS) was 1.4±0.7 (1-3) days. There were no significant differences (p > 0.05) in operative time, EBL, or LOS in comparing therapeutic to prophylactic mastectomies. Follow-up revealed no postoperative wound infections. Conclusions: Combined mastectomy with immediate reconstruction and gynecologic risk reducing surgery had no untoward surgical complications with a zero postoperative wound infection rate. Although a small study population, results indicate this approach is a prudent and feasible multidisciplinary model that can be offered to BRCA mutation carriers.