743 Feasibility and the efficacy of RRSO combined with simultaneous mastectomy and breast reconstruction in BRCA 1–2 patients

Introduction/Background* Hereditary BRCA 1-2 mutations are known risk factors for the development of breast and ovarian cancer. Risk-Reducing Salpingo-Oophorectomy (RRSO) and bilateral mastectomy are the only effective risk-reducing strategies for these patients. Commonly these are two step surgical procedures performed separately. The aim of this study was to evaluate the feasibility and the efficacy of RRSO, combined with simultaneous mastectomy and breast reconstruction in BRCA 1-2 mutation carriers. Methodology We conducted an observational retrospective study on patients with BRCA 1-2 mutation who undergone combined and simultaneous laparoscopic RRSO and mastectomy with breast reconstruction at the Gynaecology Clinic of Padua and Breast Unit of Veneto Institute of Oncology (IOV). Inclusion criteria: patients with BRCA 1-2 mutation, consent to simultaneous surgery. We collected data about age, menopausal status, history of breast carcinoma, pre-operative CA-125 levels, transvaginal-ultrasound features before surgery, operative times, intra and post-operative complications, follow up (FUP) information after RRSO and satisfaction about the simultaneous procedure. Result(s)* We included 40 patients: baseline characteristics are reported in table 1. RRSO was performed in all patients. 37 women underwent to bilateral mastectomy and 3 to monolateral mastectomy (all with breast reconstruction). The mean operative time was 229.6 ± 50.7 minutes (48 ± 16.9 minutes for the RRSO, 147.1 ± 43.6 for mastectomy and reconstruction with a mean surgical team changing time of 34.4 ± 19.6 minutes). No operative complications were reported for RRSO; concerning breast surgery we reported 4 cases of prosthesis loss and one of breast hematoma with a median FUP of 20 months (6-95). The mean hospitalization days was 3.4 ± 2.3. After one months after surgical procedure all patients expressed high satisfaction about the simultaneous surgery. Conclusion* RRSO combined with simultaneous mastectomy and breast reconstruction is feasible, effective and provides an intriguing option for BRCA 1-2 mutation carriers. A single time for anaesthesia, hospitalization and a not increased complication rate lead to high satisfaction of the patients. Nevertheless, patient’s selection should be carefully performed and surgical teams have to be properly instructed and coordinated.