Genetic Mutation Carriers: Special Considerations for Their Influence on a Modern Breast Reconstruction Practice

With medical advancement, increasing numbers of genetic variations and mutations are being uncovered that offer greater insight into which patients have a predisposition for the development of breast cancer. Reasonable management for these patients includes high-risk surveillance, medical prophylaxis, or bilateral prophylactic mastectomy with immediate reconstruction which is becoming increasingly popular. However, this cohort of patients differs from the average breast cancer patient in that they are typically younger and may have distinct reconstructive objectives for their outcomes. This chapter considers this unique and expanding population, as well as their expectations for surgical outcomes both aesthetically and oncologically. We will discuss the evolving role of social media in this population, with patient to patient virtual information sharing and how this may impact patient referrals in a manner diverging from traditional hospital-based patterns. Furthermore, we discuss how practices in which cutting-edge and novel surgical treatments are available, such as pre-pectoral and single stage reconstruction, and that incorporate team collaboration with the surgical oncologist to deliver aesthetically pleasing results with nipple sparing mastectomy and concealed scars may ultimately be attractive to genetic mutation carriers concerned not only with risk reduction but also post-operative aesthetics.