Contralateral Prophylactic Mastectomy

• Contralateral Prophylactic Mastectomy removes the healthy breast in individuals with unilateral breast cancer to prevent a new primary cancer.
• It is primarily considered by those with a high genetic risk, such as BRCA1/2 mutations.
• Benefits include significantly reduced risk of a new primary breast cancer and potential peace of mind.
• Risks encompass surgical complications, psychological impact, and the fact that it generally does not improve overall survival for most women.
• The decision to undergo CPM should involve thorough discussion with a healthcare team, weighing individual risk factors and preferences.

What is Contralateral Prophylactic Mastectomy?

Contralateral Prophylactic Mastectomy (CPM) is a surgical procedure where the unaffected breast is removed in a patient who has been diagnosed with cancer in the other breast. The primary goal of CPM is to significantly reduce the risk of developing a new, independent primary breast cancer in the healthy breast. This differs from a unilateral mastectomy, which only removes the cancerous breast.

The decision to undergo CPM is highly individualized and typically considered by women with a significantly elevated risk of developing a second primary breast cancer. This includes individuals with known genetic mutations, such as BRCA1 or BRCA2, which are associated with a substantially increased lifetime risk of breast cancer. For these high-risk individuals, understanding contralateral prophylactic mastectomy involves recognizing its potential to lower future cancer risk, even though the procedure itself carries its own set of considerations.

According to the American Cancer Society, while a woman with breast cancer has an increased risk of developing a new cancer in the opposite breast, this risk varies greatly depending on factors like age, tumor characteristics, and genetic profile. For those with a strong family history or genetic predisposition, CPM can be a critical component of their long-term cancer prevention strategy.

Benefits and Risks of Contralateral Mastectomy

The decision to undergo contralateral mastectomy for breast cancer prevention involves carefully weighing potential benefits against inherent risks. For select high-risk individuals, CPM can offer significant advantages, primarily reducing the likelihood of a new primary cancer in the healthy breast. Studies have shown that for women with BRCA1/2 mutations who have already been diagnosed with breast cancer, CPM can reduce the risk of a new contralateral breast cancer by over 90%. This reduction can provide considerable peace of mind for some patients, knowing they have taken proactive steps to mitigate future cancer risk.

However, it is crucial to understand the comprehensive CPM surgery risks and benefits. While effective at reducing the risk of a new primary cancer, CPM does not typically improve overall survival for most women with unilateral breast cancer. This is because the primary determinant of survival is usually the existing cancer and its treatment, rather than the risk of a new cancer in the opposite breast. The procedure itself carries standard surgical risks, including:

• Infection: A common complication following any surgery.
• Bleeding: Hematoma formation at the surgical site.
• Pain: Both acute post-operative pain and potential for chronic pain.
• Seroma: Accumulation of fluid under the skin, often requiring drainage.
• Anesthesia complications: Risks associated with general anesthesia.
• Numbness: Loss of sensation in the breast and armpit area.

Beyond surgical complications, there are also significant psychological and cosmetic considerations. Patients may experience changes in body image, anxiety, or depression following the removal of a healthy breast. The recovery period for a bilateral mastectomy is also typically longer and more involved than for a unilateral procedure. Therefore, a thorough discussion with a multidisciplinary healthcare team, including surgeons, oncologists, and genetic counselors, is essential to ensure patients make an informed decision aligned with their personal values and medical profile.