Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review

October 1, 2023
3:19 pm

‘Outcomes of Women undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review by Griffin C, et al.'

This is the first and very important step to establish national surgical guidelines for contralateral mastectomy (CM); facilitating equitable access, validating contralateral mastectomy as an alternative to reconstruction, and ensuring informed choice for all women facing mastectomy for breast cancer. The authors come from the Bristol Medical School, Bristol Breast Care Centre, King’s College Hospital, and Flat Friends UK and the project is headed up by Professor of Surgical Oncology and Oncoplastic breast surgeon, Shelley Potter. The results evaluated outcomes for 1954 women, in 15 separate studies, who underwent bilateral mastectomy without reconstruction after unilateral breast cancer and found high levels of decision satisfaction alongside significantly lower complication rates than for reconstructive surgery. Published on 25th September 2023 in The Annals of Surgical Oncology, this systemic review concludes that the ‘data should give surgeons the confidence to offer the procedure as an alternative option for symmetry’.

“Key themes identified across the studies were flat denial, stigma, and gender-based assumptions all of which combine to make the current complex, local pathways to contralateral mastectomy a significant challenge for the many women who do not want, or cannot have, reconstruction. In contrast to reconstruction, surgeons have no guidelines to facilitate access to contralateral mastectomy and therefore many cite funding restraints as one of the barriers preventing access to the procedure, despite its considerable cost advantages.”

Quote - Sam Brunsden, Flat Friends Trustee

The next phase of the project is already underway with a formal evaluation of current practice using Hospital Episode Statistics (HES) data and a questionnaire which is being sent out to all breast care centres. The concluding phase will involve all key stakeholders in a programme of meetings to establish the guidelines: including patients, surgeons, psychologists and specialist nurses in collaboration with the professional associations and charities.