Prophylactic Mastectomy and Breast Reconstruction in Patients at High Risk for Breast Cancer

Abstract

This paper summarizes key issues pertinent to oncologic and surgical outcomes of risk-reducing mastectomy and reconstruction. Among BRCA 1/2 mutation carriers who present with initial breast cancer, risk-reducing mastectomy in patients who are young at time of initial breast cancer diagnosis have the greatest absolute reduction in contralateral breast cancer risk associated with contralateral risk-reducing mastectomy. Although retrospective studies are suggestive of a survival advantage conferred by risk-reducing mastectomy in BRCA ½ carriers, additional research in the contemporary era of magnetic resonance screening is necessary. A wide variety of reconstructive options are available after risk-reducing mastectomy. Long-term patient-reported outcomes favor autologous tissue reconstruction techniques. The decision for risk-reducing surgery and mastectomy reconstruction in patients with increased genetic propensity for breast cancer is multifaceted, with multiple factors pertinent to consideration including type of mastectomy, timing, and method of reconstruction. Shared informed decision making is critical to optimize outcomes. Appropriate patient counseling based on growing evidence regarding patient-reported outcomes should be provided in order to tailor therapeutic recommendations.