title: Prophylactic mastectomy with immediate reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via a transmammary route: a novel surgical approach to female BRCA-mutation carriers.
abstract: BACKGROUND
  Breast reconstruction with salpingo-oophorectomy can easily be performed in patients with genetic mutations increasing the risk for mammary and ovarian carcinoma. However, many patients are skeptical about having several surgeries, as they may result in additional anesthesiological risks as well as multiple visible scars. Therefore, the purpose of this study was to evaluate the feasibility of prophylactic mastectomy and breast reconstruction combined with simultaneous transmammary salpingo-oophorectomy for BRCA carriers.
  
  
  METHODS
  Of the six patients (1 %) who chose prophylactic mastectomy with salpingo-oophorectomy at our hospital four patients had BRCA-1 mutations, one patient had a BRCA-2 mutation and one patient had a family inheritance pattern with no mutations. All patients chose to reduce their risk for mammary and ovarian cancer by undergoing bilateral mastectomy and bilateral salpingo-oophorectomy. Prophylactic mastectomy with immediate reconstruction was performed, followed by bilateral salpingo-oophorectomy with a procedure that relies on transmammary access and reduces the number of necessary surgeries without compromising cosmetic results, surgical risks and operating time.
  
  
  RESULTS
  The mean age of the patients was 46.7 ± 1.8 years (SD). The mean operative time was 190.2 ± 13.7 min. No complications were observed during the operations. The mean intra-operative loss of blood was 363.3 ± 77.9 ml. The operative method was successful in all six cases and was performed with no complications. All of the patients were satisfied with the cosmetic results.
  
  
  CONCLUSIONS
  In conclusion, prophylactic mastectomy and breast reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via transmammary access is feasible, easy to perform and provides an intriguing and novel approach to female BRCA carriers who desire operative prophylactic measures in one surgical session with no visible abdominal scars and no additional risks and complications.
authors.affiliation: 1st Department of Obstetrics and Gynecology, Campus Innenstadt, Ludwig-Maximilians-University Munich, Maistrasse 11, 80337, Munich, Germany.
authors.forename: Marta
authors.initials: M
authors.lastname: Perabò
authors.forename: Visnja
authors.initials: V
authors.lastname: Fink
authors.forename: Maria
authors.initials: M
authors.lastname: Günthner-Biller
authors.forename: Vera
authors.initials: V
authors.lastname: von Bodungen
authors.forename: Klaus
authors.initials: K
authors.lastname: Friese
authors.forename: Darius
authors.initials: D
authors.lastname: Dian
mesh_terms: D016063:Blood Loss, Surgical; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006579:Heterozygote; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control; D010052:Ovariectomy / Q000379:methods; D017060:Patient Satisfaction; D058994:Salpingectomy / Q000379:methods