title: Bilateral mastectomy and the retreat from breast-conserving surgery.
abstract: The purpose of this study is to assess the consequences for breast cancer patients of the trend away from breast conservation in favor of bilateral and contralateral mastectomy. The methods are followed from the review of the literature from 1991 to 2015. Breast-conserving surgery and sentinel lymph node biopsy, introduced into mainstream practice in the 1980s and 1990s, respectively, are now the standard of care for early-stage breast cancer. Disruptive change has unexpectedly supervened in the guise of bilateral mastectomy for cancer or prophylaxis and contralateral prophylactic mastectomy. These operations are now being resorted to at a rate which cannot be explained by any of the biological imperatives related to breast cancer and related diseases. This phenomenon extends across the Western world and beyond, driven by patients' cancer concern, a misunderstanding of what surgery can and cannot achieve and preserve, and the current popular media/cultural environment. These developments and their consequences for patients are reviewed. Surgical complications, especially those related to reconstruction, are unusually common. Of equal or greater concern are the physical, esthetic, psychosocial, psychosexual morbidities, and other adverse sequelae of these operations.
authors.affiliation: Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery (310T), University of Miami School of Medicine, 1120 N.W. 14th St, 4th Floor, Miami, FL, 33136, USA. fmoffat@med.miami.edu.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Moffat
authors.affiliation: Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery (310T), University of Miami School of Medicine, 1120 N.W. 14th St, 4th Floor, Miami, FL, 33136, USA.
authors.forename: Danny
authors.initials: D
authors.lastname: Yakoub
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control / Q000601:surgery*; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011379:Prognosis; D065286:Prophylactic Surgical Procedures; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D059039:Standard of Care; D016019:Survival Analysis
keywords: Bilateral mastectomy (BM); Breast cancer; Contralateral prophylactic mastectomy (CPM)