Twenty-five years of risk-reducing mastectomies and immediate breast reconstruction—lessons learned from a single institution

Kerstin Sandelin, Jessica Gahm, Inkeri Schultz


Risk-reducing mastectomy is an established surgical option for patients with inherited high risk for breast cancer. At the Karolinska University Hospital, a structured care plan for this patient group has been developed over a 25-year period. This paper describes the gradual evolution of patient care and surgical technique at a single high-volume university hospital. The results presented are based upon multidisciplinary collaborative efforts, prospective and retrospective studies and the patients’ and their partners’ own experiences after approximately 700 risk-reducing mastectomies. For women at high risk for breast cancer, a multidisciplinary approach is considered crucial for both pre- and postoperative assessment. The importance of accurate and personalized preoperative counseling and patient participation in decision making is stressed, and different surgical techniques are described.