A 35-year-old woman with BRCA2 mutation, no personal cancer history, and a 10-year risk of >25% requests risk-reduction surgery. She opts for bilateral prophylactic mastectomy. The most widely accepted reconstruction technique offering the best cosmetic outcome while preserving skin is:

• A Simple mastectomy with split-skin grafting
• B Radical (Halsted) mastectomy with pectoralis flap
• C Modified radical mastectomy with delayed tissue expander
• D Nipple-sparing mastectomy with immediate implant reconstruction ✓

Explanation

Nipple-sparing mastectomy (NSM) with immediate implant-based reconstruction is the current preferred approach for prophylactic mastectomy in BRCA carriers, providing maximal cosmesis while reducing breast cancer risk by >95%. The Halsted radical mastectomy removes pectoralis muscles and is obsolete for prophylactic intent. Simple mastectomy with skin grafting gives poor cosmesis. Delayed reconstruction with tissue expanders is suboptimal compared to immediate NSM.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.