Comment on postmastectomy breast reconstruction for women with hereditary gastric and breast cancer syndrome

Abstract

With great interest, we have read the article 'Postmastectomy Breast Reconstruction for Women with Hereditary Gastric and Breast Cancer Syndrome' by De Lorenzi et al. (2023). The authors present a narrative review on their most used approaches for breast reconstruction in patients with hereditary gastric and breast cancer syndrome. The most extensively studied hereditary cancer syndromes (HCS) are BRCA1-and BRCA2-associated. Other genes, besides CDH1, that are associated with HCS, are TP53 in Li-Fraumeni syndrome, Phosphatase tensin homolog (PTEN) in Cowden syndrome, mismatch repair genes in Lynch syndrome, STK11 in Peutz-Jeghers syndrome, and NF1 in neurofibromatosis type 1 syndrome (Corso et al., 2020;Piombino et al., 2020). The authors structure their article, based on three different groups of women with hereditary breast cancer. First, they provide an overview of healthy women seeking prophylactic mastectomy, then for the group of women with breast cancer, requiring mastectomy of the affected breast and prophylactic mastectomy of the contralateral breast, and lastly, the women who underwent breast-conserving treatment, followed by adjuvant radiotherapy, who opt for risk-reducing mastectomies and reconstruction after radiotherapy. For us, it is unclear why the authors present the surgical approach for breast reconstruction specifically for women with a CDH1 genetic mutation, as the three scenarios presented are applicable to all women who opt for preventive mastectomy.De Lorenzi et al. (2023) achieve great results mainly using implant-based reconstruction. Due to extensive negative media attention on silicone breast implants in the Netherlands, the preference of a significant number of patients in our center has shifted towards autologous breast reconstruction. The Maastricht University Medical Center (MUMC+) is an expert center for autologous (tertiary) breast reconstruction and therefore our approach differs in certain parts from the approach of the authors. In this comment, we would like to elucidate the differences and illustrate our approach.

Reply to comment on ‘postmastectomy breast reconstruction for women with hereditary gastric and breast cancer syndrome’

“…We have read with great interest the comment by Berben et al . (Berben and van der Hulst, 2023) on our recent article entitled ‘Postmastectomy breast reconstruction for women with hereditary gastric and breast cancer syndrome’ (De Lorenzi et al , 2023), in which we provide a schematic guide for breast reconstruction after mastectomy in women with hereditary gastric and breast cancer syndrome. We really appreciated their different approach to breast reconstruction in this specific subgroup of women at high-risk for breast cancer, providing further details on reconstructive techniques not mentioned in our paper.…”