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Related Experiment Video

Updated: Jun 3, 2026

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction

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Occult malignancy in patients undergoing contralateral prophylactic mastectomy.

Tari A King1, Inga Gurevich, Rita Sakr

  • 1Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. kingt@mskcc.org

Annals of Surgery
|March 5, 2011
PubMed
Summary

Contralateral prophylactic mastectomy (CPM) in breast cancer patients rarely reveals occult malignancy. Patient age and progesterone receptor status may predict high-risk lesions, but CPM is not supported for average-risk women.

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Area of Science:

  • Oncology
  • Breast Surgery
  • Pathology

Background:

  • Increasing rates of contralateral prophylactic mastectomy (CPM) raise questions about its benefit for average-risk breast cancer patients.
  • Identifying predictors for occult malignancy or high-risk lesions (HRL) in the contralateral breast is crucial for patient selection for CPM.

Purpose of the Study:

  • To determine factors predicting occult malignancy or HRL in the contralateral breast among women undergoing CPM.
  • To aid in selecting patients who may benefit most from CPM.

Main Methods:

  • Retrospective analysis of 2965 patients undergoing mastectomy with CPM for unilateral stage 0-III breast cancer (1997-2005).
  • Univariate and multivariate logistic regression analyses were employed to identify predictive factors for HRL and/or occult contralateral breast cancer (CBC).

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Last Updated: Jun 3, 2026

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Main Results:

  • Of 407 patients undergoing CPM, 6% had occult CBC and 28% had HRL.
  • Multifocality/multicentricity of the primary cancer was linked to occult malignancy on univariate analysis (OR 2.88, P=0.04).
  • Patient age and progesterone receptor positivity of the primary cancer were associated with malignancy or HRL on multivariate analysis.

Conclusions:

  • Multifocality/multicentricity of invasive index cancer is associated with occult malignancy in CPM, but definitions and pathology variations limit preoperative application.
  • Low rates of occult CBC do not currently support routine CPM for average-risk women with newly diagnosed breast cancer, pending identification of reliable predictors.