WTP8.6 Contralateral symmetrising mastectomy: A systematic review of clinical and patient reported outcomes

Abstract

Abstract Background Breast reconstruction is offered in the UK to restore symmetry after unilateral mastectomy (UM) for cancer but not all women want (or are suitable for) reconstruction. Contralateral symmetrising mastectomy (CSM) to provide ‘flat symmetry’ is an excellent alternative, but no NICE guidelines to support the offer of the procedure exist. Furthermore, symmetrising mastectomy is often mislabelled as ‘prophylactic’ mastectomy. As this is not recommended for women at population breast cancer risk surgeons are often reluctant to offer the procedure. Methods A systematic search in MEDLINE, PubMed, CINAHL and PsycINFO identified studies published in English 01/01/2000 - 30/08/2022 evaluating clinical and/or patient-reported outcomes of women receiving CSM after/with UM for breast cancer. Analysis included simple summary statistics for quantitative data and content analysis for qualitative data. Results After de-duplication, 1872 abstracts remained, 89 full-text articles were reviewed and 15 studies (13 quantitative, 1 qualitative and 1 study with both components) reporting outcomes in 1,954 women undergoing CSM were included in the review. Surgical complication rates were the same or higher in bilateral mastectomy versus UM, but far lower than those following reconstruction. A theme of ‘flat denial’ amongst surgeons emerged but patients universally reported high levels of satisfaction with their decision. Conclusions High-quality evidence of the clinical and patient-reported outcomes of CSM is needed to inform evidence-based surgical decision making, but such data are currently lacking. CSM is safer than reconstruction and associated with high patient satisfaction making it an excellent option for women who choose to go flat.