Bilateral risk-reducing mastectomy in a patient over 50 years of age: case report with an emphasis on the psychological aspect in the face of serious complications

ABSTRACT

Malignant breast neoplasia is the main cause of cancer mortality in women in Brazil, after non-melanoma skin cancer, and about 5 to 10% of these cases are associated with family inheritance; BRCA1 and BRCA2 genes are the most frequently mutated. In this sense, there has been a paradigm shift in medical practice regarding breast cancers in recent years, with the implementation of risk-reducing surgical procedures, such as bilateral mastectomy and salpingo-oopherectomy, which still have controversies in the indication, in addition to fears and sufferings of patients, before and after the procedure. A 54-year-old female patient has been undergoing routine examinations since 2009 (49 years), as she has a family history of breast cancer. In May 2014 (54 years old), the patient underwent genetic research, discovering the pathogenic 648delT mutation in heterozygosity in the BRCA1 gene. Although complementary exams did not indicate any neoplasia, the patient wanted to undergo risk-reducing surgery. After interprofessional discussion with the patient, bilateral risk-reducing mastectomy and salpingo-oophorectomy were performed. The patient had a postoperative infection, and one of the silicone prostheses was removed from her breast. In 2015 (55 years old), she underwent a new prosthesis inclusion, evolving without complications. Currently, she is being followed up and without evidence of active cancer disease. Despite the complication with the prosthesis, there was an improvement in psychological aspects that bothered her, referring to a reduction in anxiety and fear of cancer. Although beneficial, risk-reducing mastectomy has associated risks, especially in patients with advanced age and comorbidities. However, with an appropriate approach and focused on the complexities of each person, it is possible to provide the patient with a better overall psychological experience, as demonstrated in this case reported.