Prophylactic mastectomies in patients with breast cancer and known germline pathogenetic variants: an Austrian registry

Abstract

Objectives Risk-reducing surgeries are common in patients with breast cancer gene (BRCA) mutations. Certain patients develop breast cancer before they opt for these surgeries. We aimed to examine the frequency of risk-reducing mastectomies and salpingo-oophorectomy among Austrian patients with breast cancer and BRCA mutations. Methods In 2014, we established an Austrian registry with patients with known germline pathogenetic variants. From onset until 2018, 111 patients were recruited from four breast cancer centers. Data on the type of mastectomy, reconstructions, and complications were collected. Results Of all patients, 13.5% had bilateral breast cancer. Among patients with unilateral breast cancer, the majority (86.8%) opted for prophylactic mastectomy on the contralateral side. Those who underwent modified radical mastectomy were more likely to choose prophylactic surgery (p = 0.001). A total of 19.4% of patients experienced cancer relapse postoperatively. Immediate reconstructions were recorded in 71.3% of the patients. In addition, patients undergoing immediate reconstruction were more likely to undergo a prophylactic operation on the contralateral side than those with delayed reconstruction (p = 0.001). A mesh was used in 47.8% of all reconstructions. The subpectoral implant was present in 75.6% of patients and the pre-pectoral in 13.3%. A mesh was inserted in all patients with pre-pectoral implants. Conclusion The results indicate that the willingness for risk-reducing surgeries is high and the option for immediate reconstruction is preferably selected by the patients with breast cancer.