Abstract
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.
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Fisher ER, Fisher B, Sass R, Wickerham L. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol no. 4) XI: bilateral breast cancer.Cancer 1984;54:3002–11.
Robbins GF, Berg JW. Bilateral primary breast cancers: a prospective clinicopathological study.Cancer 1964;17:1501–27.
Beuchler PK. Patient selection for prophylactic mastectomy: Who is at high risk?Plast Reconstr Surg 1983;72:324–31.
Anderson DE, Badzioch MD. Risk of familial breast cancer.Cancer 1985;56:383–7.
Ottman R, Pike MC, King MC, et al. Familial breast cancer in a population-based series.Am J Epidemiol 1986;123:15–21.
Lesser ML, Rosen PP, Kinne DW. Multicentricity and bilaterality in invasive breast carcinoma.Surgery 1982;91:234–40.
Rosen PP. Lobular carcinoma in situ and intraductal carcinoma of the breast.Mongr Pathol 1984;25:59–105.
Hartrampf CR, Scheflan M, Black P. Breast reconstruction with a transverse abdominal island flap.Plast Reconstr Surg 1982;69:216.
Hartrampf CR, Bennett GK. Autogenous tissue reconstruction in the mastectomy patient: a critical review of 300 patients.Ann Surg 1987;205:508.
Kroll SS, Baldwin B. A comparison of outcomes using three different methods of breast reconstruction.Plast Reconstr Surg 1992;90:455.
Leis HP Jr. Selective prophylactic contralateral mastectomy.Cancer 1971;28:956–61.
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Kroll, S.S., Miller, M.J., Schusterman, M.A. et al. Rationale for elective contralateral Mastectomy with immediate bilateral reconstruction. Annals of Surgical Oncology 1, 457–461 (1994). https://doi.org/10.1007/BF02303609
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DOI: https://doi.org/10.1007/BF02303609