Autologous flap reconstruction as a unique opportunity for weight loss and breast cancer risk reduction: A case report

Objective:​ The purpose of this paper is to discuss how autologous flap reconstruction following mastectomy can serve as a unique opportunity for patients with breast cancer to reduce their risk of recurrence through weight reduction in the pre-operative, intraoperative and postoperative phases of healing.  Background: Autologous mastectomy reconstruction with tissue from the lower abdomen is common. Patients, with breast cancer, who test positive for the BRCA gene are known to have a survival benefit from prophylactic mastectomy. It is also known that satisfaction for autologous breast reconstruction is high in the patient population with a high body mass index (BMI). This population has the unique opportunity to further reduce their risk of breast cancer through weight loss.  Methods: Prior to surgery, our patients are instructed to consume a high protein diet intake on the magnitude of 1-2 grams per/kg of body weight which was on average 80-100 grams of protein per day. A case report chart review was conducted on a breast cancer patient who underwent autologous breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. The patient had a high body mass index on the initial presentation of their breast cancer diagnosis. After the bilateral mastectomies, the patient lost additional weight after the completion of autologous flap reconstruction.  Results: Our patient with a high body mass index, who underwent bilateral mastectomy with autologous flap reconstruction, was followed between 2018 and 2020. Aesthetic outcome and weight loss following reconstruction was evaluated at various time points. Weight loss, as documented in chart review and patient report, was examined as well as before and after photographs post autologous flap reconstruction.  Conclusions: Bilateral mastectomy is a common procedure and typical among patients with BRCA positivity or other strong family history of breast cancer. Although mastectomy reduces the risk of recurrence, the risk reduction is not zero. Breast cancer patients often wish to complete all possible modalities to reduce their risk of recurrence. We have found that weight loss is often a controllable risk factor that patients often choose to pursue.