Implant-Based Breast Reconstruction after Risk-Reducing Mastectomy in BRCA Mutation Carriers: A Single-Center Retrospective Study

Abstract

Women with BRCA gene mutations have a higher lifetime risk of developing breast cancer. Furthermore, cancer is usually diagnosed at a younger age compared to the wild-type counterpart. Strategies for risk management include intensive surveillance or risk-reducing mastectomy. The latter provides a significant reduction of the risk of developing breast cancer, simultaneously ensuring a natural breast appearance due to the preservation of the skin envelope and the nipple-areola complex. Implant-based breast reconstruction is the most common technique after risk-reducing surgery and can be achieved with either a submuscular or a prepectoral approach, in one or multiple stages. This study analyzes the outcomes of the different reconstructive techniques through a retrospective review on 46 breasts of a consecutive, single-center case series. Data analysis was carried out with EpiInfo version 7.2. Results of this study show no significant differences in postoperative complications between two-stage tissue expander/implant reconstruction and direct-to-implant (DTI) reconstruction, with DTI having superior aesthetic outcomes, especially in the prepectoral subgroup. In our experience, the DTI prepectoral approach has proven to be a safe and less time-consuming alternative to the submuscular two-stage technique, providing a pleasant reconstructed breast and overcoming the drawbacks of subpectoral implant placement.

Counselling Framework for Germline BRCA1/2 and PALB2 Carriers Considering Risk-Reducing Mastectomy

“…Implants may be placed under the pectoralis major muscle (retropectoral or subpectoral), partially submuscular (dual-plane), or above the pectoralis muscle (prepectoral) [72]. Over the last decade, techniques in implant-based reconstruction have shifted from two-stage fully submuscular tissue expander (TE) placement to single-stage dual-plane or prepectoral reconstruction with or without an acellular dermal matrix [73]. The advantages of prepectoral reconstruction include reduced postoperative pain, the avoidance of animation deformity (superior implant migration with pectoral muscle contraction), and improved cosmetic outcomes due to a more natural breast projection and contour [74][75][76].…”

Modern Approaches and Future Perspectives on Breast and Ovarian Cancer Prevention Strategies in BRCA1 and BRCA2 Mutation Carriers: A Literature Overview

“…Majority of high-risk patients are provided with classic, implant-based methods. [19] In the past, a two-stage breast reconstruction was commonly performed, but nowadays it is primarily reserved for patients at high risk of postoperative complications. Among the remaining patients, immediate reconstruction, also known as direct-to-implant (DTI) procedure, is favored.…”

“…Among the remaining patients, immediate reconstruction, also known as direct-to-implant (DTI) procedure, is favored. [19] In recent times, there have been advancements in reconstructive techniques using autologous tissues. The assembly of trans rectus abdominis myocutaneous flap (TRAM) is the most frequently employed technique using self-derived materials.…”