Left Breast Cancer in a BRCA2 Carrier Treated With Mastectomy, Chemotherapy, and an Arm Port

What happened, in summary

A 36-year-old woman found a lump in her left breast in March 2021 and was diagnosed with multicentric invasive breast cancer involving the axillary lymph nodes. The tumor was hormone receptor-positive and HER2-negative, and genetic testing identified a pathogenic BRCA2 variant.

Breast surgery was delayed for more than a month when she developed symptomatic COVID-19. After recovering, she underwent bilateral nipple-sparing mastectomy in May 2021, with left axillary dissection and immediate reconstruction. The left-breast specimen showed two invasive tumor areas, and 18 of 30 left axillary nodes were involved.

She then received anthracycline-taxane chemotherapy through an implantable port placed in her upper right arm rather than the chest. Left-sided radiotherapy was completed, and endocrine therapy with abemaciclib was started. The arm-port approach was chosen partly to avoid another visible scar on the chest. At 17 months after surgery, she was free from disease and reported very good quality of life, including little impact from the mastectomy, reconstruction, or port on daily activities, body image, work, or sexual life.