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Contralateral prophylactic mastectomy

Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Section Editors
Russell S Berman, MD
Harold Burstein, MD, PhD
Deputy Editor
Sadhna R Vora, MD


Patients with a unilateral sporadic breast cancer are at a modest risk of developing an invasive contralateral breast cancer (CBC). While most women never will develop a contralateral second primary breast cancer, risk-reducing strategies may be appropriate for some. A contralateral prophylactic mastectomy (CPM) is a risk-reducing mastectomy performed in the clinical setting for the patient diagnosed with an invasive or a noninvasive breast cancer. While there is no clear survival benefit for most breast cancer patients who do not carry a deleterious BRCA1 or BRCA2 mutation [1-3], the rates of performing a CPM have increased over the last several years [4,5].

The risk of a contralateral breast cancer, the decision-making process to undergo a CPM, and outcomes will be reviewed in this topic. Management of patients with invasive and noninvasive breast cancer, with and without an inherited genetic mutation, is reviewed separately. Medical therapy for breast cancer risk reduction is also reviewed separately.

(See "Overview of the treatment of newly diagnosed, non-metastatic breast cancer".)

(See "Ductal carcinoma in situ: Treatment and prognosis".)

(See "Overview of hereditary breast and ovarian cancer syndromes".)

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Literature review current through: Nov 2017. | This topic last updated: Jul 11, 2017.
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  1. Bedrosian I, Hu CY, Chang GJ. Population-based study of contralateral prophylactic mastectomy and survival outcomes of breast cancer patients. J Natl Cancer Inst 2010; 102:401.
  2. Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev 2010; :CD002748.
  3. Metcalfe K, Gershman S, Ghadirian P, et al. Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis. BMJ 2014; 348:g226.
  4. King TA, Sakr R, Patil S, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol 2011; 29:2158.
  5. Zeichner SB, Zeichner SB, Ruiz AL, et al. Improved long-term survival with contralateral prophylactic mastectomy among young women. Asian Pac J Cancer Prev 2014; 15:1155.
  6. McDonnell SK, Schaid DJ, Myers JL, et al. Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. J Clin Oncol 2001; 19:3938.
  7. Herrinton LJ, Barlow WE, Yu O, et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol 2005; 23:4275.
  8. Schell SR, Montague ED, Spanos WJ Jr, et al. Bilateral breast cancer in patients with initial stage I and II disease. Cancer 1982; 50:1191.
  9. Chaudary MA, Millis RR, Hoskins EO, et al. Bilateral primary breast cancer: a prospective study of disease incidence. Br J Surg 1984; 71:711.
  10. Garcia-Etienne CA, Barile M, Gentilini OD, et al. Breast-conserving surgery in BRCA1/2 mutation carriers: are we approaching an answer? Ann Surg Oncol 2009; 16:3380.
  11. Trainer AH, Lewis CR, Tucker K, et al. The role of BRCA mutation testing in determining breast cancer therapy. Nat Rev Clin Oncol 2010; 7:708.
  12. Graeser MK, Engel C, Rhiem K, et al. Contralateral breast cancer risk in BRCA1 and BRCA2 mutation carriers. J Clin Oncol 2009; 27:5887.
  13. https://www.nccn.org/professionals/physician_gls/pdf/breast_risk.pdf (Accessed on February 16, 2017).
  14. Wong SM, Freedman RA, Sagara Y, et al. Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer. Ann Surg 2017; 265:581.
  15. Abbott A, Rueth N, Pappas-Varco S, et al. Perceptions of contralateral breast cancer: an overestimation of risk. Ann Surg Oncol 2011; 18:3129.
  16. van Sprundel TC, Schmidt MK, Rookus MA, et al. Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers. Br J Cancer 2005; 93:287.
  17. Rosenberg SM, Sepucha K, Ruddy KJ, et al. Local Therapy Decision-Making and Contralateral Prophylactic Mastectomy in Young Women with Early-Stage Breast Cancer. Ann Surg Oncol 2015; 22:3809.
  18. Rosenberg SM, Tracy MS, Meyer ME, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med 2013; 159:373.
  19. Güth U, Myrick ME, Viehl CT, et al. Increasing rates of contralateral prophylactic mastectomy - a trend made in USA? Eur J Surg Oncol 2012; 38:296.
  20. Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998-2007. Ann Surg Oncol 2010; 17:2554.
  21. Yi M, Hunt KK, Arun BK, et al. Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic mastectomy. Cancer Prev Res (Phila) 2010; 3:1026.
  22. Arrington AK, Jarosek SL, Virnig BA, et al. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol 2009; 16:2697.
  23. Chung A, Huynh K, Lawrence C, et al. Comparison of patient characteristics and outcomes of contralateral prophylactic mastectomy and unilateral total mastectomy in breast cancer patients. Ann Surg Oncol 2012; 19:2600.
  24. Goss PE, Ingle JN, Alés-Martínez JE, et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med 2011; 364:2381.
  25. Murthy V, Chamberlain RS. Prophylactic mastectomy in patients at high risk: is there a role for sentinel lymph node biopsy? Clin Breast Cancer 2013; 13:180.
  26. Nasser SM, Smith SG, Chagpar AB. The role of sentinel node biopsy in women undergoing prophylactic mastectomy. J Surg Res 2010; 164:188.
  27. Kurian AW, Lichtensztajn DY, Keegan TH, et al. Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998-2011. JAMA 2014; 312:902.
  28. Pesce C, Liederbach E, Wang C, et al. Contralateral prophylactic mastectomy provides no survival benefit in young women with estrogen receptor-negative breast cancer. Ann Surg Oncol 2014; 21:3231.
  29. Fayanju OM, Stoll CR, Fowler S, et al. Contralateral prophylactic mastectomy after unilateral breast cancer: a systematic review and meta-analysis. Ann Surg 2014; 260:1000.
  30. Donovan CA, Bao J, Gangi A, et al. Bilateral Mastectomy as Overtreatment for Breast Cancer in Women Age Forty Years and Younger with Unilateral Operable Invasive Breast Cancer. Ann Surg Oncol 2017; 24:2168.
  31. Evans DG, Ingham SL, Baildam A, et al. Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer. Breast Cancer Res Treat 2013; 140:135.
  32. El-Tamer MB, Ward BM, Schifftner T, et al. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg 2007; 245:665.
  33. Hynes DM, Weaver F, Morrow M, et al. Breast cancer surgery trends and outcomes: results from a National Department of Veterans Affairs study. J Am Coll Surg 2004; 198:707.
  34. Eck DL, Perdikis G, Rawal B, et al. Incremental risk associated with contralateral prophylactic mastectomy and the effect on adjuvant therapy. Ann Surg Oncol 2014; 21:3297.
  35. Osman F, Saleh F, Jackson TD, et al. Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol 2013; 20:3212.
  36. Gopie JP, Mureau MA, Seynaeve C, et al. Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer. Fam Cancer 2013; 12:479.
  37. Brandberg Y, Sandelin K, Erikson S, et al. Psychological reactions, quality of life, and body image after bilateral prophylactic mastectomy in women at high risk for breast cancer: a prospective 1-year follow-up study. J Clin Oncol 2008; 26:3943.
  38. Unukovych D, Sandelin K, Liljegren A, et al. Contralateral prophylactic mastectomy in breast cancer patients with a family history: a prospective 2-years follow-up study of health related quality of life, sexuality and body image. Eur J Cancer 2012; 48:3150.
  39. Frost MH, Slezak JM, Tran NV, et al. Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol 2005; 23:7849.
  40. Han E, Johnson N, Glissmeyer M, et al. Increasing incidence of bilateral mastectomies: the patient perspective. Am J Surg 2011; 201:615.
  41. Carr-Hill RA. The measurement of patient satisfaction. J Public Health Med 1992; 14:236.
  42. Homer JJ, Sheard CE, Jones NS. Cognitive dissonance, the placebo effect and the evaluation of surgical results. Clin Otolaryngol Allied Sci 2000; 25:195.
  43. van Oostrom I, Meijers-Heijboer H, Lodder LN, et al. Long-term psychological impact of carrying a BRCA1/2 mutation and prophylactic surgery: a 5-year follow-up study. J Clin Oncol 2003; 21:3867.
  44. Chagpar AB. Skin-sparing and nipple-sparing mastectomy: preoperative, intraoperative, and postoperative considerations. Am Surg 2004; 70:425.
  45. Burger A, Thurtle D, Owen S, et al. Sentinel lymph node biopsy for risk-reducing mastectomy. Breast J 2013; 19:529.