Management of Young, High Risk Women with BRCA Mutations

What is it about?

Growing public awareness of BRCA 1/2 genetic mutations, in combination with other factors, has led to increased genetic testing as well as higher rates of prophylactic mastectomies in younger high-risk patients. Genetic testing for BRCA 1/2 should be reserved in the majority of instances for patients greater than 18 years of age and requires appropriate pre-test genetic counseling. Prophylactic mastectomy is usually performed at the later young adult age range and must be individualized according to each patient’s risk of cancer as well as level of maturity, lifestyle and autonomy. Prophylactic mastectomy in young adults can serve to relieve crippling fears of developing cancer but also has significant psychosocial ramifications. Nipple-sparing mastectomy allows for excellent cosmetic outcomes in this patient population and immediate implant reconstruction has further allows patients to return to their “normal” lifestyles sooner while avoiding difficulties of expansion process. However, breast reconstruction, particularly single-stage reconstruction, requires extensive preoperative discussion and counseling on risks and potential complications that can be devastating in young patients undergoing prophylactic surgery. In the end, a multi-disciplinary approach with focus on preemptive counseling and comprehensive care is key for managing young female patients with high-risk breast cancer genetic mutations.

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Why is it important?

Young BRCA+ patients undergoing mastectomy have unique surgical and psychosocial needs.