| Abstract [eng] |
Aim: This study aims to analyze the surgical techniques utilized for prophylactic mastectomies at the Plastic and Reconstructive Surgery Centre of Vilnius University Hospital Santaros Clinics from 2018 to 2023. It seeks to investigate the factors influencing the selection of these techniques and evaluate their oncological safety as well as postoperative complications. Methods: We conducted a retrospective analysis of subjects who underwent one- or two-stage prophylactic mastectomy at the VUL SK Plastic and Reconstructive Surgery Centre from January 2018 to November 2023, specifically due to identified genetic mutations. The study received approval from the Vilnius Regional Biomedical Research Ethics Committee (Authorization No. 2023/12-1548-1017). Statistical analysis was carried out using Microsoft Office Excel and RCommander software packages. Results: Our study included 84 patients with a mean age of 43.8 (±9.2) years. The distribution of identified genetic mutations was as follows: BRCA1 in 76.62%, BRCA2 in 25%, and CHECK2 in 2.38% of cases. Approximately half of the patients (51.19%) had a history of breast cancer, while the remaining 48.81% had no such history. There was no statistically significant association (p = 0.6) between the subjects' oncological history and the type of confirmed genetic mutation. Regarding surgical procedures, 63.16% of patients underwent single-stage surgery, while 36.84% underwent reduction/mastopexy in the first stage followed by prophylactic mastectomy in the second stage. In two-stage operations, the mean time between preparatory surgery and prophylactic mastectomy was 268.96 (±159.55) days. We observed a statistically significant association between the choice of surgical approach and patients' breast ptosis (p < 0.001) and the distance from the sternal notch to the nipple (p < 0.001). Furthermore, the time from consultation to mastectomy was significantly longer with the two-stage method compared to the single-stage approach (p < 0.001). However, no statistically significant difference (p > 0.99) was found in oncological safety between these two methods. Postoperative complications occurred in 9.2% of all patients and were independent of the surgical method (p > 0.99) and patients' age (p = 0.74). However, there was a significantly higher rate of complications in patients who underwent a single-stage operation (p = 0.038), particularly those with higher breast ptosis. Conclusions: The mean age of patients undergoing prophylactic mastectomies due to inherited genetic mutations from 2018 to 2023 was 43.8 (±9.2) years. BRCA1 was the predominant genetic mutation, observed in 72.62% of cases, followed by BRCA2 and CHECK2 mutations, found in 25% and 2.38% of cases, respectively. During the study period, prophylactic mastectomy was performed in one stage for 63.16% of patients and in two stages for 36.84% of patients. The choice of surgical method was influenced by factors such as breast ptosis and the distance from the sternal notch to the nipple-areola complex. Although the preoperative approach resulted in a doubled interval between consultation and prophylactic mastectomy, it did not compromise oncological safety. Postoperative complications were not influenced by the age of the subjects or the chosen surgical approach. However, one-stage surgery was associated with a significantly higher rate of complications in patients with a higher grade breast ptosis. |
