Prophylactic mastectomy and simultaneous reconstruction

Abstract

Background. Prophylactic Mastectomy (PM) meets several controversies which are especially: the value of PM for preventing breast cancer and also the extent of the mastopathy drug therapy that may reduce the risk of breast cancer without requiring PM. Materials and methods. PM was performed on 7 patients, aged between 25 and 41 years. Preoperative examination included ultrasound, mammography, CT, MRI (two cases), cytology, tests BRCA-1 and BRCA-2. Subcutaneous PM was performed bilaterally in 5 cases. In two cases of breast cancer PM was performed unilaterally for contrlateral gland. In 6 cases the operation was finished with reconstruction breast implant. Each case of PM had an individual type of incision depending on the presence and location of previous scars after the sectorial resection of the breast and degree of breast sagging. Simultaneous breast reconstruction was performed in 5 cases with implants. Results and discussion. Two patients had a pronounced ischemia of areola and nipple. The decrease skin and areola sensitivity was observed in all cases. There has been no extrusion of the implant, no breast inflammation or contracture in the postoperative period. The aesthetic result of breast reconstruction for PM "skin sparing" mastectomy after reconstruction is superior to classical mastectomy. Conclusions. We consider defining the following criteria of PM: aggravated familiar history, previously supported contralateral cancer, multicenter and multifocal cancer, age of patient, histologic factor and positive BRCA 1 and BRCA-2 tests. The decision in favor of PM should be taken only after thorough examination and in full agreement with the patient.Originality and scientific relevance of the presented study. Originality and scientific relevance of the presented study. Breast cancer is the most common form of malignancy in women that causes humanity a significant loss via not only important financial aspects, but also a high rate of physical and intellectual disability. Fibrocystic mastopathy is held responsibble for increased risk of breast carcinoma, serving as prediction marker of histological lesion or malignacy. The question is whether prophylactic treatment alone is enough or surgery has to be carried out in order to eliminate unnoticed debutant cancer.