title: A new strategy for prophylactic surgery in BRCA women: Combined mastectomy and laparoscopic salpingo-oophorectomy with immediate reconstruction by double DIEP flap.
abstract: BACKGROUND
  Prophylactic surgery remains the most effective modality for reducing both breast and ovarian cancer rate in woman at high risk, such as BRCA1 or BRCA2. Autologous breast reconstruction with bilateral deep inferior epigastric perforator (DIEP) flap allows predictable and durable results. However, existing two-step approach separating salpingo-oophorectomy and reconstruction could even make DIEP flap impossible, or make insufflation more difficult during laparoscopy. Other authors described one-step procedure but with open laparotomy. The goal of this study was to verify the feasibility of a simultaneous procedure, including laparoscopic salpingo-oophorectomy.
  
  
  METHODS
  We included BRCA mutation careers scheduled for simultaneous laparoscopic salpingo-oophorectomy, and bilateral breast reconstruction with DIEP flaps. The first step of the procedure was laparoscopic salpingo-oophorectomy and ports had to be strategically placed to avoid interference with the following procedure. The second step was bilateral breast reconstruction with DIEP flaps. We reviewed medical charts. Surgical procedure was analyzed for duration, revisions and surgical complications.
  
  
  RESULTS
  During 1-year period, eight patients agreed to a simultaneous procedure. All of them were BRCA positive, mean age was 38.3years (range, 39-50), and mean BMI was 28.3kg/m(2) (range, 21-33). The mean duration of the entire procedure was 524minutes (range, 405-630) and the mean hospital stay 9.2 days (range, 8-14). There was 100% flap survival. No abdominal wall dehiscence occurred.
  
  
  CONCLUSIONS
  One-step procedure for prophylactic surgery of ovarian and breast hereditary malignancies is feasible. First salpingo-oophorectomy with open laparoscopy then bilateral immediate or delayed breast reconstruction with DIEP flaps can be performed.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Georges-Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France. Electronic address: vhunsi@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Hunsinger
authors.affiliation: Department of Plastic and Reconstructive Surgery, Georges-Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: A C
authors.initials: AC
authors.lastname: Marchac
authors.affiliation: Department of Plastic and Reconstructive Surgery, Georges-Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Derder
authors.affiliation: Department of Plastic and Reconstructive Surgery, Georges-Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Hivelin
authors.affiliation: Department of Gynaecological Oncology, Georges-Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Lecuru
authors.affiliation: Department of Gynaecological Oncology, Georges-Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: A-S
authors.initials: AS
authors.lastname: Bats
authors.affiliation: Department of Plastic and Reconstructive Surgery, Georges-Pompidou European Hospital, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Lantieri
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control; D005185:Fallopian Tube Neoplasms / Q000235:genetics / Q000517:prevention & control; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006579:Heterozygote; D006801:Humans; D010535:Laparoscopy; D016462:Mammaplasty; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control; D010052:Ovariectomy; D000072036:Prophylactic Mastectomy; D065286:Prophylactic Surgical Procedures; D012189:Retrospective Studies; D058994:Salpingectomy; D013524:Surgical Flaps
keywords: BRCA; Breast reconstruction; DIEP; Laparoscopie; Laparoscopy; Oophorectomy; Ovariectomie; Reconstruction mammaire; Simultaneous; Simultanée