Bilateral prophylactic mastectomy as an option for prevention of contralateral breast cancer

Abstract

The article discusses the risk factors for contralateral breast cancer and the role of prophylactic bimastectomy in reducing these risks. Breast cancer is the most frequent cancer among women. Several strategies have been implemented to reduce the risk of occurrence and recurrence of breast cancer: lifestyle changes, early detection through diagnosis and screening, chemotherapy, and surgery. Prophylactic mastectomy is one of the growing strategies to reduce the risk of breast cancer. Evidence suggests that the incidence of prophylactic bimastectomy in patients with unilateral breast cancer is steadily increasing, due not only to cancer case but also with requirements in women to modern quality of life. For women who choose or need to undergo a therapeutic mastectomy, removal of the contralateral breast is often discussed. Although the risk of contralateral breast cancer is relatively low for patients without hereditary genetic mutations with an established primary diagnosis of breast cancer, the total number of women who are at risk of developing contralateral breast cancer has increased markedly over the past few decades. Thus, among the risk factors influencing the occurrence of cancer in the contralateral healthy breast are young women with breast cancer, genetic mutation carriers, strong family history, ductal non-invasive cancer, tumour characteristics, which are indication to bilateral prophylactic mastectomy with immediate breast reconstruction. However, at the present stage of development oncoplastic and reconstructive breast cancer surgery, in the leading position one of the indications for prophylactic contralateral subcutaneous mastectomy with immediate breast reconstruction - is the patient's desire to preserve aesthetics and femininity. The level of satisfaction among women with bilateral mastectomy and breast reconstruction is higher than in women with unilateral mastectomy and reconstruction. Improvement of reconstructive and surgical techniques for performing contralateral prophylactic mastectomy provides the best aesthetic result among patients. Therefore, the present data requires a more detailed study of this issue and approval in the scientific community.