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Timing of Prophylactic Oophorectomy, mastectomy and microsurgical breast reconstruction in BRCA1 and BRCA2 carriers
Ibrahim Khansa, MD;
Duane Wang, BS;
Michelle Coriddi, MD;
Pankaj Tiwari, MD
The Ohio State University Wexner Medical Center
2013-02-28
Presenter: Ibrahim Khansa, MD
Affidavit:
The material presented in this abstract is Dr. Khansa's original work, and has not been previously published in any journal or presented at any meeting.
Director Name: Gregory Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: BRCA carriers are at high risk of developing breast and ovarian malignancies, and thus often undergo prophylactic total abdominal hysterectomy-bilateral salpingo-oophorectomy (TAH-BSO), bilateral mastectomy and breast reconstruction. These procedures can interfere with each other depending on the chronologic order in which they are performed.
Methods: All patients who underwent microsurgical breast reconstruction at our institution between 2007 and 2012 were studied. Abdominal wall complications were analyzed in BRCA carriers with a history of TAH-BSO, and those without. This was compared to non-BRCA carriers with prior abdominal surgery who underwent microsurgical breast reconstruction.
Results: 442 patients underwent 612 microsurgical breast reconstructions, 47 of whom were BRCA carriers. 37 BRCA carriers had a TAH-BSO. Flap type was a major predictor of requiring mesh for fascial closure and of hernia/bulge, while prior TAH-BSO was not. In five patients with prior TAH-BSO, the flap choice had to be altered due to injury to the deep inferior epigastric artery or scarring of the rectus muscle. Robotic TAH-BSO after microsurgical breast reconstruction took significantly longer to perform due to abdominal wall tightness (4h 29min vs. 3h 14min, p<0.01). However, no robotic TAH-BSO was converted to open.
Conclusions: In BRCA carriers with a previous history of TAH-BSO, a DIEP flap may not be feasible if scarring of the rectus muscle precludes intramuscular dissection of perforators. However, abdominal wall complications are not increased. On the other hand, robotic TAH-BSO performed after microsurgical breast reconstruction takes longer, but can still be performed safely.
