[Prophylactic mastectomies and immediate breast reconstruction in patients at very high genetic risk: our experience with 14 cases].
OBJECTIVE
Prophylactic mastectomy has been the subject of major publications by international groups. Its oncology benefit is undisputed in patients with a genetic mutation. Nevertheless, its impact on quality of life, its psychological, esthetic, sexual, functional and pain repercussions are such that it should not and must never be programmed in an emergency situation. We report our experience with 14 patients at very high genetic risk having undergone a bilateral prophylactic mastectomy with immediate breast reconstructive surgery.


METHODS
From 1 March 2001 to 31 March 2006, 14 patients at very high genetic risk, seven of whom had a history of breast cancer, underwent immediate breast reconstruction with skin sparing mastectomy and preservation of the nipple-areolar complex.


RESULTS
In 71.5% of the cases, we obtained a definitive conservation of the nipple-areolar complex, with esthetic results judged very satisfying.


CONCLUSIONS
Immediate bilateral breast reconstruction by provisional or definitive implant with conservation of the skin flap and the nipple-areolar complex may constitute a positive radical issue for requesting and motivated patients at high genetic risk, managed by a multidisciplinary team.
Unité de chirurgie carcinologique et reconstructrice mammaire, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94800 Villejuif, France. marie-christine.missana@orange.fr
M-C
MC
Missana
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A
Chompret
D000328:Adult; D018427:Breast Implants; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D009154:Mutation; D017060:Patient Satisfaction; D018579:Patient Selection; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D016896:Treatment Outcome