Contralateral Prophylactic Mastectomy
Contralateral prophylactic mastectomy refers to removal of the healthy breast in someone who currently has or has had breast cancer in the other breast. It may be recommended by breast surgeons for patients with the any of the following:
- A genetic defect that predisposes them to breast cancer, such as BRCA1 or BRCA2 mutations
- A high risk for developing breast cancer
- Breasts that are difficult to screen due to extremely dense breast tissue or widespread calcifications
- A desire for symmetry and reconstruction of both breasts using the same method
The rate of patients undergoing contralateral prophylactic mastectomy has risen significantly in the United States. Many studies have looked at why patients have chosen to have their healthy breasts removed. Besides the medically indicated reasons for performing contralateral prophylactic mastectomy (for example, genetic counseling and testing, family history, and high-risk factors for developing breast cancer in the future), many women are requesting this surgery because of fear of cancer recurrence, the stress surrounding close follow-up, and information they have received regarding contralateral breast cancer risk and risk for local recurrence.
Many patients estimate their risk of developing breast cancer in their healthy breast at 30% in 10 years, but medical studies show that only 3% to 5% of early breast cancer patients will develop contralateral breast cancer over 10 years’ time. Also contralateral prophylactic mastectomy does not prevent the development of metastatic disease, except in a very small group of patients. These select patients, young women with early-stage estrogen receptor (ER)-negative breast cancer, may derive a 1% disease-free survival benefit from contralateral prophylactic mastectomy over the course of 20 years.
It is important to realize all surgery carries risks. Additional surgery can also impose a risk of additional surgical complications. Studies have shown that the addition of a contralateral prophylactic mastectomy carries a 1.5-times risk of any complication and a 2.7-times risk of a major complication, compared to patients undergoing a single-sided mastectomy of the breast containing cancer.
Removal of the healthy breast will also affect the sensation and function of the nipple. If the nipple is removed, this will be completely lost. If a nipple-sparing mastectomy is performed, the nipple will not feel the same or react the same way to stimulation. Reconstructed breasts may feel “heavier” than normal breast tissue. Certain types of reconstruction, especially those involving implants, may require subsequent surgeries if the implant fails.
Patients should carefully consider their personal benefits and risks when deciding about whether contralateral prophylactic mastectomy is right for them. Discussion with their breast surgeon and, if available, the recommendations of a multidisciplinary tumor board are encouraged.
American Society of Breast Surgeons Consensus Statements on Contralateral Prophylactic Mastectomy
Soran A, Polat A, McGuire K. Increasing trend of contralateral prophylactic mastectomy: What are the factors behind the phenomenon? The Surgeon. 2014;12:316-322.
Portschy P, Kuntz K, Tuttle T. Survival outcomes after contralateral prophylactic mastectomy:a decision analysis. J Natl Cancer Inst. 2014;106:dju160. doi: 10.1093/jnci/dju160.
Miller ME, Czechura T, Martz B, et al. Operative risks associated with contralateral; prophylactic mastectomy: a single institution review. Ann Surg Oncol. 2013;20:4113-4120.