Abstract
Background: Breast reconstruction (BR) is routinely offered to restore symmetry after mastectomy for breast cancer. Not all women, however, may want reconstructive surgery. A contralateral mastectomy (CM) to achieve ‘flat symmetry’ can be an excellent alternative but surgeons are often reluctant to offer this procedure. This systematic review aimed to summarise the available evidence regarding the outcomes of CM as the first step to developing guidelines in this area.
Methods: MEDLINE, PubMed, CINAHL and PsycINFO were searched to identify primary research studies, published in English between 1/1/2000-30/8/2022 evaluating clinical or patient-reported outcomes of women who underwent a CM, without reconstruction, after a mastectomy for unilateral breast cancer. Simple descriptive statistics summarised quantitative data and content analysis was used for qualitative data.
Results: 15 studies (13 quantitative, 1 qualitative and 1 mixed-methods) evaluating outcomes in at least 1,954 women who had undergone a bilateral mastectomy without reconstruction (BM) after unilateral breast cancer were included. The risk of surgical complications after BM was higher than after UM but significantly less than after BR. Satisfaction with decision for BM was high in all studies. Key themes relating to flat denial, stigma, and gender-based assumptions were identified.
Discussion: Women electing to undergo BM report high levels of satisfaction with their decision and similar complication rates to UM. Further work is needed to comprehensively explore the outcomes for women seeking BM, but these data should give surgeons confidence to offer the procedure as an alternative option for symmetry after unilateral mastectomy for breast cancer.
Methods: MEDLINE, PubMed, CINAHL and PsycINFO were searched to identify primary research studies, published in English between 1/1/2000-30/8/2022 evaluating clinical or patient-reported outcomes of women who underwent a CM, without reconstruction, after a mastectomy for unilateral breast cancer. Simple descriptive statistics summarised quantitative data and content analysis was used for qualitative data.
Results: 15 studies (13 quantitative, 1 qualitative and 1 mixed-methods) evaluating outcomes in at least 1,954 women who had undergone a bilateral mastectomy without reconstruction (BM) after unilateral breast cancer were included. The risk of surgical complications after BM was higher than after UM but significantly less than after BR. Satisfaction with decision for BM was high in all studies. Key themes relating to flat denial, stigma, and gender-based assumptions were identified.
Discussion: Women electing to undergo BM report high levels of satisfaction with their decision and similar complication rates to UM. Further work is needed to comprehensively explore the outcomes for women seeking BM, but these data should give surgeons confidence to offer the procedure as an alternative option for symmetry after unilateral mastectomy for breast cancer.
| Original language | English |
|---|---|
| Pages (from-to) | 303-315 |
| Number of pages | 13 |
| Journal | Annals of Surgical Oncology |
| Volume | 31 |
| Issue number | 1 |
| Early online date | 25 Sept 2023 |
| DOIs | |
| Publication status | Published - 1 Jan 2024 |
Bibliographical note
Funding Information:This work was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. Shelley Potter (SP) is an NIHR Clinician Scientist (CS-2016-16-019) Katherine Fairhurst is an NIHR Academic Clinical Lecturer. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Funding Information:
This work was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. Shelley Potter (SP) is an NIHR Clinician Scientist (CS-2016-16-019) Katherine Fairhurst is an NIHR Academic Clinical Lecturer. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2023, The Author(s).
Keywords
- breast cancer
- mastectomy
- systematic review
- symmetry
