Postoperative complications of breast risk-reduction surgery in very high risk breast cancer patients: A series of 253 cases.

Background: This study assesses surgical practices and complications related to risk-reducing mastectomy in patients at very high risk for breast cancer. Methods: A retrospective study was conducted among women over 18 years of age who had undergone risk-reducing mastectomy from January 2015 to April 2022 at the Toulouse-Oncopole University Cancer Institute. Results: For the 253 patients having undergone risk-reducing mastectomy between 2015 and 2022, mean age was 43 years, with a majority of patients carrying BRCA1 (48.6%) or BRCA2 mutations (38.3%). Three-quarters of patients (67.6%) underwent prosthetic reconstruction, 17% free-flap reconstruction, and 7% latissimus dorsi flap reconstruction. At least one postoperative complication was experienced by 43% of patients, mostly wound healing disorders (34.9%). A complication requiring no further intervention was recorded in 32% of patients. A further 11.1% required reoperation. Implant loss occurred in 3.5% of patients undergoing prosthetic reconstruction. The rate of free flap loss was 5.9%. Discussion and conclusion: The overall complication rate of 43% aligns with findings from other studies on risk-reducing mastectomy, with notable variations between prosthetic and autologous reconstructions. This study highlights the high complication rates associated with risk-reducing mastectomies, especially in patients undergoing free-flap reconstruction. Despite these challenges, the rates of reconstruction failure and severe complications remain relatively low. Understanding patient-specific risk factors and surgical modalities can help in counseling patients and managing their expectations about potential postoperative issues.