Department of Breast Oncology, Aichi Cancer Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
Department of Plastic and Reconstructive Surgery, Aichi Cancer Hospital, Nagoya, Japan.
Breast Cancer. 2018 Sep;25(5):539-546. doi: 10.1007/s12282-018-0850-z. Epub 2018 Mar 8.
Contralateral risk-reducing mastectomy (CRRM) for breast cancer patients with BRCA mutations has been reported to not only reduce breast cancer incidence but also to improve survival. The National Comprehensive Cancer Network guidelines recommend providing CRRM to women with BRCA mutations who desire CRRM after risk-reduction counseling. However, in Japan, CRRM cannot be performed generally because it is not covered by health insurance. Thus, we conducted a feasibility study to confirm the safety of CRRM.
CRRM with bilateral breast reconstructions were performed for breast cancer patients with BRCA mutations. The primary endpoint was early adverse events within 3 months, and secondary endpoints were late adverse events.
Between August 2014 and November 2016, ten patients were enrolled. The median age was 37.5 years, and five of the patients had the BRCA1 mutation while five had the BRCA2 mutation. Six patients received neoadjuvant chemotherapy. Eight patients selected silicone breast implants, and two patients selected transverse rectus abdominis myocutaneous flap reconstruction. Pathological findings showed no evidence of occult breast cancers in any of the patients. At a median of 25.5 months follow-up time, CRRM-related early adverse events were hematoma (subsequently removed by re-operation; grade 2, n = 1), wound infection (grade 2, n = 1), skin ulceration (grade 1, n = 2) and wound pain (grade 1, n = 1). Overall, there were no grade 3 or more severe adverse events.
Our results confirm that CRRM with reconstruction could be performed safely.
携带 BRCA 突变的乳腺癌患者行对侧预防性乳房切除术（CRRM）不仅可以降低乳腺癌的发生率，还可以提高生存率。美国国家综合癌症网络指南建议，在风险降低咨询后，有 BRCA 突变且希望行 CRRM 的女性可以提供 CRRM。然而，在日本，CRRM 通常不能进行，因为它不在医疗保险范围内。因此，我们进行了一项可行性研究以确认 CRRM 的安全性。
对携带 BRCA 突变的乳腺癌患者行 CRRM 并进行双侧乳房重建。主要终点是术后 3 个月内的早期不良事件，次要终点是晚期不良事件。
2014 年 8 月至 2016 年 11 月，共纳入 10 例患者。中位年龄为 37.5 岁，5 例患者携带 BRCA1 突变，5 例患者携带 BRCA2 突变。6 例患者接受新辅助化疗。8 例患者选择硅胶乳房植入物，2 例患者选择横行腹直肌肌皮瓣重建。病理检查结果显示所有患者均无隐匿性乳腺癌证据。中位随访时间为 25.5 个月，CRRM 相关的早期不良事件包括血肿（随后通过再次手术清除；2 级，n=1）、伤口感染（2 级，n=1）、皮肤溃疡（1 级，n=2）和伤口疼痛（1 级，n=1）。总体而言，无 3 级或更严重的不良事件。
我们的研究结果证实，CRRM 联合重建可以安全进行。
