Oncologic Considerations for Timing of Breast Reconstruction and Prophylactic Mastectomy in Breast Cancer Patients

Omar Beidas, Oscar Talledo and William Dooley

Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA

^*Correspondance to: William C Dooley 

 PDF  Full Text DOI: 10.25107/2474-1647.1721

Abstract

Background: In an era of more conservative breast cancer treatment, a recent trend has led to an increased rate of mastectomy as risk-reduction surgery or as a component of achieving symmetry in reconstruction. This article aims to review the most up-to-date information regarding: the safety of Skin-Sparing (SSM) and nipple-sparing mastectomies (NSM) as compared to traditional modified radial mastectomies as well as their patterns of recurrence, and the recurrence and second malignancy rates of breast cancer after Breast Conservation Therapy (BCT) and mastectomy based on different cancer biologies.Methods: PubMed and Ovid databases were queried online. Articles were reviewed for pertinent information, along with their references to capture all possible variables in decision making about reconstruction in newly diagnosed breast cancer patients.Results: Patients with low-penetrance gene mutations, no family history, or luminal A type breast cancers should be counseled that their risk of local recurrence or contralateral breast cancer is low. These patients are ideal candidates for BCT or mastectomy with immediate reconstruction of the ipsilateral breast alone and this can occur at any time during the treatment process. Women with high-penetrance gene mutations; a strong family history—defined as 3 or more relatives with positive history; luminal B, HER2, or triple negative tumor types; or high anxiety about future risk of breast cancer, should be advised to consider contralateral risk-reduction mastectomy. These patients may have life-saving benefits from timely radiation or chemotherapy and may need to consider delaying or staging prophylactic and reconstruction surgeries until completion of systemic oncologic therapies.Conclusion: Breast cancer treatment and reconstruction has evolved drastically in the past 100 years. However, as new treatment modalities have developed and pooled data is made available, differences have been teased among the various cancer subtypes and patient populations. Oncologic treatment and reconstruction must be based on each patient’s individual situation and desires. An algorithm is included to assist in the decision-making process of the breast cancer patient.

Keywords

Breast; Breast cancer; Breast reconstruction; Chemotherapy; Contralateral breast cancer; Lumpectomy; Mastectomy; Metastasis; Oncology; Radiation; Recurrence; Risk reduction

Cite the article

Beidas O, Talledo O, Dooley W. Oncologic Considerations for Timing of Breast Reconstruction and Prophylactic Mastectomy in Breast Cancer Patients. Clin Surg. 2017; 2: 1721.