Two-stage risk-reducing breast surgery with a synthetic matrix: a case report
DOI:
https://doi.org/10.29289/2594539420260012Palavras-chave:
surgical mesh, implants, mammoplasty, mastectomy, subcutaneous mastectomy, quality of lifeResumo
Risk-reducing mastectomy is a well-established strategy for patients at high risk of developing breast cancer, particularly those with known genetic mutations. However, in women presenting with large breasts and significant ptosis, skin-reducing mastectomy with immediate reconstruction is associated with higher rates of surgical complications, including skin flap necrosis, wound dehiscence, and implant-related issues. In this context, a staged surgical approach has been proposed as a safe alternative. The case of a 48-year-old asymptomatic woman carrying a germline pathogenic mutation in the TP53 gene, consistent with Li-Fraumeni syndrome, who presented with large breasts and grade III ptosis is reported. In this patient, a two-stage risk-reducing surgical approach was adopted. Initially, the patient underwent reduction mammoplasty to improve breast shape and optimize skin envelope conditions. This was followed by bilateral nipple-sparing mastectomy with immediate prepectoral implant-based reconstruction assisted by a bioabsorbable synthetic matrix (GORE® BIO-A®). The study was approved by the Institutional Ethics Committee (CAAE: 73596023.4.1001.5040), and written informed consent was obtained. Postoperatively, the patient developed a localized hematoma and partial superficial nipple necrosis, both of which were managed conservatively without the need for surgical reintervention. At 60 days of follow-up, the patient presented satisfactory aesthetic outcomes, with good breast contour, no requirement for opioid analgesia, and absence of animation deformity. A staged surgical approach may reduce complications and enhance aesthetic outcomes in patients with large and ptotic breasts undergoing risk-reducing mastectomy. Prepectoral reconstruction using a bioabsorbable synthetic matrix appears to be a safe and effective option in carefully selected cases. Further prospective studies are necessary to validate these findings and establish long-term outcomes.
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Copyright (c) 2026 Amanda de Queiroz Germano, Francisco Pimentel Cavalcante, Marcelo Antonini, Antônio Luiz Frasson, Fabricio Palermo Brenelli, Felipe Pereira Zerwes, Eduardo Camargo Millen, André Mattar
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
