Research and Development

Contralateral symmetrising mastectomy: A systematic review of clinical and patient reported outcomes.

The abstract ‘Contralateral symmetrising mastectomy: A systematic review of clinical and patient reported outcomes’ was accepted for poster presentation at the Association of Breast Surgery (ABS) conference in May 2023.

Accepted posters are displayed for viewing across this two-day event which is attended by hundreds of surgeons, nurses, and professionals from the UK and British Isles.

‘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.

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Feel amazing and inspire change by helping us fund life-changing research!

We are excited to be working closely with renowned academics and surgeons embarking on research into mastectomy options.

Our patient survey in 2020 found that over half of women who had a mastectomy did not feel they were fully informed about all their surgical options and 1 in 4 women had their request for flat symmetry refused. Those women who are not having breast reconstruction are facing obstacles, additional hurdles and discrimination.

This research project would begin by analysing current UK mastectomy practice right across the NHS. The aim is to then use the findings to develop improved guidelines ensuring information about all options post mastectomy are provided to every woman at time of diagnosis. We aim to remove the barriers and postcode lottery of access to informed choice and flat symmetry as an alternative to breast reconstruction after mastectomy.

Survey conducted by Flat Friends finds that patients facing mastectomy are denied information and treatment options.

Breast cancer charity, Flat Friends, has written to the National Institute for Clinical Excellence and Matt Hancock MP asking for breast cancer patients to be better informed of their mastectomy options.
New survey finds 53 per cent of women don’t feel informed of all the surgery options available to them after their mastectomy.
Less than a third of women (32%) are given information about going fully flat i.e. having the cancer-free breast removed to achieve symmetry, with only 11 per cent offered it as an option.
NICE guidelines currently only give the option of reconstruction to achieve symmetry.
92% of women denied surgery to go fully flat are dissatisfied with how they look in the mirror compared to 6% who were allowed.

Read the Press Release 08 March 2021

Flat Friends is the UK’s only charity dedicated to – and solely focused on – supporting women who have had mastectomy without reconstruction, and those facing that decision.

Help us reach our 2022 target of £10,000, and fund the life-changing research women facing mastectomy surgery really need.

You can fundraise your way! We have lots of fundraising ideas and resources on our website to help get you started. You could also support us by ordering from our new awesome range of Tshirts and hoodies.

Tollow 2019 Womens experiences of decision making around Contralateral Prophylactic Mastectomy (CPM)

Flat Friends UK is proud to have taken part in this study by the Centre for Appearance Research, University of the West of England, which was published in Psycho-Oncology in April 2019. The paper investigated women’s experiences of decision making around CPM (Contralateral Prophylactic Mastectomy: removal of an unaffected breast) in the UK. Women described defending their decision to have CPM, and concerns their decision would be considered “abnormal”. They also shared the importance of peer support.

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Flat Friends presentation by Gilly Cant at the Association of Breast Surgery 2016

In 2015 Flat Friends UK worked alongside SHORE-C in a preliminary research study to find out what surgical options women were being offered for breast cancer. Both patients, surgeons and breast nurses were questioned in the study.

In this video, our founder, Gilly Cant, delivers some of the patient results and talks about patient choice when it comes to surgical options.
Video courtesy of Ian Cant