Risk-reducing mastectomy: a case series of 124 procedures in Brazilian patients.

PURPOSE: Women with mutations in breast cancer predisposition genes have a significantly higher lifetime risk of developing breast cancer and can opt for risk-reducing mastectomy. Women with positive family history of cancer can also opt for prophylactic surgery as a preventive method in selected cases. Current studies showed reduced risk of developing breast cancer after prophylactic nipple-sparing mastectomy, however, despite the good clinical outcomes, one of the main concerns regarding nipple-sparing mastectomy (NSM) is the oncological safety of nipple-areola complex preservation. In this study, we aimed to evaluate the indications, complication rates, and unfavorable events of 62 Brazilian patients that underwent risk-reducing NSM from 2004 to 2018. METHODS: Patient data were reviewed retrospectively and descriptive statistics were utilized to summarize the findings. RESULTS: The mean patients age was 43.8 years. The main indication for risk-reducing NSM was the presence of pathogenic mutation (53.3%), followed by atypia or lobular carcinoma in situ (25.8), and family history of breast cancer and/or ovarian cancer (20.9%). There were four (3.2%) incidental diagnosis of ductal carcinoma in situ and one invasive ductal carcinoma (0.8%). From the 124 prophylactic NSM performed, two (1.6%) complications had occurred: one (0.8%) infection and one (0.8%) partial nipple necrosis. In a mean follow-up of 50 months, there was one (1.6%) newly diagnosed breast cancer in the 62 patients undergoing prophylactic NSM. CONCLUSIONS: Our findings demonstrated efficacy and safety to perform NSM as prophylactic surgery with good oncological outcomes and low complication rates in a case series of Brazilian patients.

Prophylactic mastectomy versus surveillance for the prevention of breast cancer in women's BRCA carriers. / Mastectomía profiláctica versus vigilancia en la prevención de cáncer de mama en mujeres BRCA positivo.

INTRODUCTION: Women who have mutations in BRCA genes have a high risk of developing breast cancer. Therefore, multiple preventive strategies have been proposed, within which is prophylactic mastectomy. Considering physical and psychological effects of surgery, the controversy is established as to whether the preventive effect exceeds that of active vigilance. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 13 systematic reviews including 50 studies overall. We concluded prophylactic mastectomy is associated with frequent adverse effects, but probably reduces the incidence of breast cancer and decreases mortality, in addition to being associated with high levels of satisfaction.

INTRODUCCIÓN: Las mujeres que poseen mutaciones en genes BRCA tienen un alto riesgo de desarrollar cáncer de mama. Por lo anterior, se han planteado múltiples estrategias preventivas dentro de las cuales se encuentra la mastectomía profiláctica. Existe controversia sobre si los beneficios de esta intervención superan al de una vigilancia activa, en especial considerando el impacto físico y psicológico asociado. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 13 revisiones sistemáticas que en conjunto incluyen 50 estudios primarios. Concluímos que si bien la mastectomía profiláctica se asocia a efectos adversos frecuentes, reduce la incidencia de cáncer de mama y la mortalidad, y podría asociarse a altos niveles de satisfacción.

Mastectomía profiláctica versus vigilancia en la prevención de cáncer de mama en mujeres BRCA positivo / Prophylactic mastectomy versus surveillance for the prevention of breast cancer in women's BRCA carriers

INTRODUCCIÓN: Las mujeres que poseen mutaciones en genes BRCA tienen un alto riesgo de desarrollar cáncer de mama. Por lo anterior, se han planteado múltiples estrategias preventivas dentro de las cuales se encuentra la mastectomía profiláctica. Existe controversia sobre si los beneficios de esta intervención superan al de una vigilancia activa, en especial considerando el impacto físico y psicológico asociado. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 13 revisiones sistemáticas que en conjunto incluyen 50 estudios primarios. Concluímos que si bien la mastectomía profiláctica se asocia a efectos adversos frecuentes, reduce la incidencia de cáncer de mama y la mortalidad, y podría asociarse a altos niveles de satisfacción.

INTRODUCTION: Women who have mutations in BRCA genes have a high risk of developing breast cancer. Therefore, multiple preventive strategies have been proposed, within which is prophylactic mastectomy. Considering physical and psychological effects of surgery, the controversy is established as to whether the preventive effect exceeds that of active vigilance. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 13 systematic reviews including 50 studies overall. We concluded prophylactic mastectomy is associated with frequent adverse effects, but probably reduces the incidence of breast cancer and decreases mortality, in addition to being associated with high levels of satisfaction.

El uso de mallas parcialmente absorbibles como cobertura y sostén del polo inferior en reconstrucción mamaria / The use of meshes partially absorbable as coverage and support of the lower pole in breast reconstruction

La reconstrucción mamaria inmediata con implantes en mastectomía ahorradora de piel o adenomastectomía profiláctica presenta con frecuencia una cobertura débil y deficiente del polo inferior. Del mismo modo que en las cirugías de revisión de complicaciones de implantes mamarios por asimetrías o descenso de surco, sinmastia o contractura capsular, en nuestra práctica privada. El uso de mallas biológicas y sintéticas ha crecido a nivel mundial. Presentamos nuestra experiencia en el uso de mallas parcialmente absorbibles para la cobertura del polo inferior de la mama. Las mismas que son usadas con frecuencia en nuestro medio en cirugía general

In skin sparing mastectomy and prophylactic mastectomy with immediate breast implant reconstruction is usual the weak and deficient coverage. In the same way, the revision procedures of the breast implant complication such us bottoming out, fold malposition, synmastia or capsular contracture in our private practices. The biologic and synthetic mesh has increase all around the world in order to reinforce the lower pole. The partial absorbable mesh is our alternative in breast reconstruction and revision surgery in breast cosmetic implant