Prophylactic mastectomy: the Rotterdam experience

The efficacy of prophylactic mastectomy (PM) depends on the ability to remove all breast tissue and a regular mastectomy is recommended. In our study population (n=112), 103 women (94%) have chosen for immediate breast reconstruction (IBR) with a silicone prosthesis placed in a subpectoral pocket. The median follow-up after IBR was 3.5 (range 1-7) years. These 103 patients underwent 193 PM with IBR: 90 bilateral and 13 unilateral. The median follow-up after IBR was 3.5 (range 1-7) years. In 163 IBRs (82%) no complications were observed. The most common late complication was capsular contracture, significantly more around prostheses placed in a previously irradiated area. No cases of breast cancer were found after PM at a mean follow-up of 2.9 years. After breast cancer a delayed ipsilateral PM and/or contralateral PM can be considered after a disease-free interval of 2 years, also taking into account the age of onset of the first breast cancer. The prognosis of breast cancer in BRCA2 mutation patients seems to be similar to that in sporadic cancer. The most striking result of PM is the decrease of anxiety of developing breast cancer and a negative impact on their sexual life. Therefore a time delay is necessary to allow women to fully address the issues involved in PM and IBR.