INTRODUCTION: Carriers of genetic mutations with a high risk of developing breast cancer have a lifetime risk of this cancer of up to 70%. To reduce the risk, patients have the option of a risk-reducing mastectomy. There is limited data with only short follow-ups on its safety. The aim of the study was to determine the long-term incidence of breast cancer in healthy patients with no previous surgery, who underwent bilateral risk-reducing mastectomies (BRRMs). METHODS: We retrospectively reviewed 274 patients from our facility with no previous breast surgery, who underwent BRRM from 1981 to 2022, due to genetic mutations, a strong family history, or having very dense mammary glands. We approached these patients during their checkups, by phone call or email, and we asked them if they had developed breast cancer after their procedures. We recorded the patients' demographic factors, their genetic mutation types, and the mastectomy methods carried out. RESULTS: A total of 274 patients had BRRMs with a mean follow-up after 76 months; 208 patients had undergone nipple-sparing mastectomies, 39 patients had undergone skin-sparing mastectomies, and 27 patients had skin-reducing mastectomies. One BRCA1+ patient developed breast cancer 21 months after undergoing the risk-reducing skin-sparing mastectomy procedure. None of the patients died of breast cancer. CONCLUSIONS: The incidence of breast cancer in the monitored patients is comparable to the results of the other related studies. The study result confirms that risk-reducing mastectomies reduce the risk of breast cancer in high-risk populations, regardless of the type of mastectomy performed.

Department of General Surgery 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of General Surgery University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Plastic Surgery 3rd Faculty of Medicine Charles University Prague Czech Republic

From the Department of Plastic Surgery University Hospital Kralovske Vinohrady Prague Czech Republic

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Kuchenbaecker KB, Hopper JL, Barnes DR, et al. ; BRCA1 and BRCA2 Cohort Consortium. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317:2402–2416. PubMed

Daly MB, Pal T, Berry MP, et al. ; CGC. Genetic/familial high-risk assessment: breast, ovarian, and pancreatic, version 2.2021. J Natl Compr Canc Netw. 2021;19:77–102. PubMed

Warner E, Hill K, Causer P, et al. . Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging. J Clin Oncol. 2011;29:1664–1669. PubMed PMC

Conduit C, Milne RL, Friedlander ML, et al. . Bilateral salpingo-oophorectomy and breast cancer risk for BRCA1 and BRCA2 mutation carriers: assessing the evidence. Cancer Prev Res (Phila). 2021;14:983–994. PubMed PMC

Clarijs ME, Peeters NJMCV, van Dongen SAF, et al. . Quality of life and complications after nipple- versus skin-sparing mastectomy followed by immediate breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg. 2023;152:12e–24e. PubMed PMC

Maruccia M, Elia R, Tedeschi P, et al. . Prepectoral breast reconstruction: an ideal approach to bilateral risk-reducing mastectomy. Gland Surg. 2021;10:2997–3006. PubMed PMC

Rocco N, Montagna G, Criscitiello C, et al. . Nipple sparing mastectomy as a risk-reducing procedure for BRCA-mutated patients. Genes (Basel). 2021;12:253. PubMed PMC

Popowich B, Kostaras X, Temple-Oberle C. Breast reconstruction after therapeutic or prophylactic mastectomy for breast cancer: a comparison of guideline recommendations. Eur J Surg Oncol. 2020;46:1046–1051. PubMed

Patzelt M, Zarubova L, Vecerova M, et al. . Risk comparison using autologous dermal flap and absorbable breast mesh on patient undergoing subcutaneous mastectomy with immediate breast reconstruction. Aesthetic Plast Surg. 2022;46:1145–1152. PubMed

Liede A, Cai M, Crouter TF, et al. . Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect. Breast Cancer Res Treat. 2018;171:435–442. PubMed PMC

Evans DG, Wisely J, Clancy T, et al. . Longer term effects of the Angelina Jolie effect: increased risk-reducing mastectomy rates in BRCA carriers and other high-risk women. Breast Cancer Res. 2015;17:1–2.. PubMed PMC

Pujol P, Barberis M, Beer P, et al. . Clinical practice guidelines for BRCA1 and BRCA2 genetic testing. Eur J Cancer. 2021;146:30–47. PubMed

Ginsburg O, Bray F, Coleman MP, et al. . The global burden of women’s cancers: a grand challenge in global health. Lancet. 2017;389:847–860. PubMed PMC

Mavaddat N, Peock S, Frost D, et al. ; EMBRACE. Cancer risks for BRCA1 and BRCA2 mutation carriers: results from prospective analysis of EMBRACE. J Natl Cancer Inst. 2013;105:812–822. PubMed

Collins JM, Isaacs C. Management of breast cancer risk in BRCA1/2 mutation carriers who are unaffected with cancer. Breast J. 2020;26:1520–1527. PubMed

Boyd CJ, Ramesh S, Bekisz JM, et al. . Low cancer occurrence rate following prophylactic nipple-sparing mastectomy. Plast Reconstr Surg. 2024;153:37e–43e. PubMed

Ludwig KK, Neuner J, Butler A, et al. . Risk reduction and survival benefit of prophylactic surgery in BRCA mutation carriers, a systematic review. Am J Surg. 2016;212:660–669. PubMed

Skytte A, Crüger D, Gerster M, et al. . Breast cancer after bilateral risk-reducing mastectomy. Clin Genet. 2011;79:431–437. PubMed

Wilkinson L, Gathani T. Understanding breast cancer as a global health concern. Br J Radiol. 2022;95:20211033. PubMed PMC

Rebbeck TR, Friebel T, Lynch HT, et al. . Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2004;22:1055–1062. PubMed

Kluger J, Park A. The Angelina effect. Time. 2013;181:28–33. PubMed

Horton CE, Rosato FE, Schuler FA, III, et al. . Postmastectomy reconstruction. Ann Surg. 1978;188:773–777. PubMed PMC

Meijers-Heijboer H, van Geel B, van Putten WL, et al. . Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation abstract. N Engl J Med. 2001;345:159–164. PubMed

Pennisi VR, Capozzi A, Francisco S. Subcutaneous mastectomy data: a final statistical analysis of 1500 patients. Aesthetic Plast Surg. 1989;13:15. PubMed

Mutter RW, Frost MH, Hoskin TL, et al.. Breast cancer after prophylactic mastectomy (bilateral or contralateral prophylactic mastectomy), a clinical entity: presentation, management, and outcomes. Breast Cancer Res Treat. 2015;153:183–190. PubMed PMC

Jakub JW, Peled AW, Gray RJ, et al. . Oncologic safety of prophylactic nipple-sparing mastectomy in a population with BRCA mutations: a multi-institutional study. JAMA Surg. 2018;153:123–129. PubMed PMC

van Verschuer VMT, van Deurzen CHM, Westenend PJ, et al. . Prophylactic nipple-sparing mastectomy leaves more terminal duct lobular units in situ as compared with skin-sparing mastectomy. Am J Surg Pathol. 2014;38:706–712. PubMed

Berkeš A, Streit L, Dražan L, et al. . The comparison of effectivity in breast cancer prevention between skin sparing and subcutaneous mastectomy—20 years of experience. Acta Chir Plast. 2024;65:112–116. PubMed

Carbine NE, Lostumbo L, Wallace J, et al. . Risk-reducing mastectomy for the prevention of primary breast cancer. Cochrane Database Syst Rev. 2018;4:CD002748. PubMed PMC