Rationale for elective contralateral mastectomy with immediate bilateral reconstruction.
BACKGROUND
Women with breast cancer treated by mastectomy with immediate breast reconstruction can get exceptionally good results if the reconstruction is performed with autogenous tissue using the transverse rectus abdominis myocutaneous (TRAM) flap. Bilateral reconstruction with TRAM flaps is also possible, but only if both breasts are reconstructed at the same time. To avoid the possibility of subsequently developing contralateral malignancy and having to undergo assymetrical reconstruction with a different technique, some patients have chosen the alternative of bilateral mastectomy with bilateral immediate reconstruction. This is only reasonable if the incidence of failure in bilateral breast reconstruction is very low.


METHODS
We prospectively studied reconstructive outcomes in 100 patients who had breast cancer and who underwent bilateral mastectomy and reconstruction (using implants as well as TRAM flaps). We also reviewed the histologic findings in 88 prophylactically removed high-risk breasts.


RESULTS
Successful outcomes were initially achieved in 95 patients; of the 5 failures, two were successfully reconstructed with alternative techniques for an overall success rate of 97%. Of the 63 patients reconstructed with bilateral TRAM flaps, all but one (98%) were successful on the first try. TRAM flap reconstructions were significantly more likely to be successful than were those based on implants (p = 0.05). Previously unsuspected invasive cancer was found in 3 patients (3.4%), whereas carcinoma in situ was found in 5 patients (5.7%) and in another 18 patients (20%) cellular atypia was present.


CONCLUSIONS
Bilateral breast reconstruction has a low incidence of failure, particularly if TRAM flaps are used. For selected patients, elective contralateral mastectomy with immediate bilateral reconstruction is a reasonable treatment alternative provided that the necessary expertise is available and the patients clearly understand the risks.
Kroll
S S
SS
Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Miller
M J
MJ
Schusterman
M A
MA
Reece
G P
GP
Singletary
S E
SE
Ames
F
F
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D008327:Mammography; D015411:Mastectomy, Modified Radical; D015413:Mastectomy, Simple; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016609:Neoplasms, Second Primary / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome