Surgical Decision Making in Genetically High-Risk Women: Quantifying Postoperative Complications and Long-Term Risks...

Area of Science:

• Oncology
• Surgical Oncology
• Genetics

Background:

• Risk-reducing mastectomy (RRM) is a key breast cancer prevention strategy for high-risk individuals.
• However, RRMs can necessitate unplanned subsequent surgeries, impacting patient outcomes.
• Understanding the incidence of these supplemental surgeries is crucial for patient counseling and care planning.

Purpose of the Study:

• To determine the likelihood and patterns of supplemental surgeries following risk-reducing mastectomy (RRM) in women with germline pathogenic variants (GPV).

Main Methods:

• A retrospective cohort study included female patients with GPVs in breast cancer susceptibility genes who underwent RRM between 2006 and 2022.
• Supplemental surgeries were defined as any procedure requiring anesthesia performed outside the initial RRM plan.
• The 5-year cumulative incidence of supplemental surgery was estimated using the Kaplan-Meier method.

Main Results:

• Of 258 women undergoing RRM, 36.4% required at least one reoperation within a median follow-up of 3.8 years.
• The 5-year supplemental surgery rate was 39.2% overall.
• Early postoperative complications significantly increased reoperation rates (85.3%) compared to those without complications (29.0%).

Conclusions:

• Unanticipated supplemental surgeries are common, occurring in approximately 40% of GPV carriers post-RRM.
• Patients experiencing early postoperative complications face a substantially higher risk of reoperation.
• These findings highlight the need for comprehensive patient counseling regarding potential surgical risks and outcomes.