Multidisciplinary management of risk-reducing mastectomy and immediate reconstruction: treatment algorithm and patient satisfaction

• Published in: European journal of plastic surgery 2015-10, Vol.38 (5), p.385-390
• Main Authors: Alamouti, R., Hachach-Haram, N., Farhadi, J
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Original Paper; Plastic Surgery
• ISSN: 0930-343X; 1435-0130
• DOI: 10.1007/s00238-015-1086-1

Background Mutations in breast cancer type 1 and type 2 (BRCA 1/2) genes have been identified in populations expressing a strong family history of breast and ovarian cancers and account for 5–10 % of cases of breast cancer. The options for reconstruction in this cohort can be challenging because of the young age at which many patients present the sizeable defect and the psychosocial effect it has on their lives. A multidisciplinary one-stop clinic (MDOSC) is fundamental to their management Methods Our study included 91 patients, from July 2007 to July 2012, who underwent RRM with immediate autologous or implant-based reconstruction within our department. Women were invited to participate in the study post surgery and completed a validated Breast-Q questionnaire detailing their experience in a number of domains including body image and perception, sexuality, and cosmetic outcome. Patients were also invited to attend an individual interview for further analysis of patient experience and expectations. Results Using the questionnaire responses and private interview content, a detailed analysis of BRCA patient experience was achieved. The main concerns identified included expectations regarding the outcome and the dissatisfaction rates, less than 20 %, correlated with postoperative complication rates. Patients emphasized the importance of careful preoperative consultation with a multidisciplinary team, and >90 % cited a desire to recommend RRM with immediate reconstruction to other patients that met similar criteria. Conclusions RRM with immediate reconstruction is a good option for this unique group of patients; BRCA positive and overall patient satisfaction is high. Our study also highlights the significance of a multidisciplinary team working toward improving patient experience and outcome as well as managing patient expectations prior to surgery. Level of Evidence: Level III, risk/prognostic study.