Contralateral prophylactic mastectomy and implications for breast reconstruction

Abstract

Contralateral prophylactic mastectomy (CPM) rates have continued to rise in the United States, impacting all stakeholders including plastic and reconstructive surgeons. Multiple factors may be influencing this trend, including patient decision-making characteristics, knowledge about breast cancer disease and prognosis, advances in genetic testing and enhanced imaging capabilities, sociodemographic factors, and access to specialty surgical services such as breast reconstruction. In this review, the authors shed light on the current state of CPM and summarize the literature analyzing its increasing prevalence in the United States, as well as outline future directions for study and dissemination of knowledge from providers to patients surrounding this important and complex treatment decision.

Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction

“…Nevertheless, the long-term effects of these different treatment options on patient quality of life (QOL) have not been well studied. With rates of mastectomy and reconstruction for early-stage breast cancer increasing substantially in the US, with associated increased costs and complication burden, the need for patient-centered evidence to support the decision for breast-conserving surgery with RT vs mastectomy and reconstruction without RT has become increasingly pressing.…”

Development of the Breast Surgical Oncology Fellowship in the United States

“…Demographic factors, including younger age, white, or nonblack ethnic origin, and private health insurance are also commonly cited [ 28 ]. Evidence also suggests that the utilization of CPM is influenced by emotional factors, specifically the patient's desire to have peace of mind and reduce anxiety about experiencing a subsequent breast cancer diagnosis [ 29 ]. Regional factors also influence the use of CPM, with high rates in the southwest and low rates in the northeastern United States.…”

Prophylactic mastectomy and occult malignancy: Surgical and imaging considerations

“…[3][4][5] Escalating utilization of germline genetic testing together with improved access to chest wall reconstruction options have contributed to the increasing interest in PM. [5][6][7][8][9][10] Additionally, preoperative magnetic resonance imaging (MRI) has been associated with higher CPM receipt. 4,5,11 In preparation for surgery, breast imaging, including mammography, ultrasound, and/or MRI, is routinely obtained to assess for suspicious findings that may warrant additional preoperative workup, diagnosis, and treatment.…”

“… 3 , 4 , 5 Escalating utilization of germline genetic testing together with improved access to chest wall reconstruction options have contributed to the increasing interest in PM. 5 , 6 , 7 , 8 , 9 , 10 Additionally, preoperative magnetic resonance imaging (MRI) has been associated with higher CPM receipt. 4 , 5 , 11 …”