Genetic Testing Before DIEP Flap Reconstruction - Is It Necessary?
By: Courtney Floyd and Dr. Chet Nastala
Genetic testing is making a difference in risk management options for individuals who have an increased likelihood of developing breast cancer. For patients who elect to have genetic testing and find they carry one of the many gene mutations that increases the risk of breast cancer, prophylactic mastectomy is an option. This surgical risk-reduction approach involves removing the breast tissue – with or without sparing the nipple-areola – and can be followed by immediate breast reconstruction.
In a study published in Plastic and Reconstructive Surgery, genetic testing is now also recommended for breast cancer patients who choose to undergo a unilateral mastectomy with an abdominal based flap breast reconstruction procedure (like the DIEP flap).
The study followed 160 women with breast cancer who underwent a unilateral mastectomy followed by abdominal based flap breast reconstruction between 2007 and 2016. At an average follow-up of six years, three patients had been diagnosed with a second breast cancer in the originally unaffected breast. All three of these women proved to have a high-risk mutation that could have been detected by genetic testing before surgery.
Why is this important?
If these three women had known they were at high risk prior to their original mastectomy, they may have opted undergo a prophylactic mastectomy of the originally unaffected breast with bilateral reconstruction. This is because the abdominal based flaps can only be used once. If further mastectomy and reconstruction is necessary later, reconstruction would have to be performed using a breast implant or tissue from another area of the body.
“This study provides clear evidence that genetic testing is a must for women choosing unilateral (one sided) reconstruction,” says Dr. Chet Nastala. “Genetic testing can identify those patients who are at high risk for development of future cancers on the opposite breast which could have been prevented in hindsight. Although unilateral abdominal based reconstruction may be appropriate in select patients, this would not be the case if a genetic risk was identified beforehand. We would encourage all women to be fully aware of their genetic risk status as they plan their reconstruction.”