Symmetric Breast Surgery: Balancing Procedures versus Prophylactic Mastectomy and Immediate Reconstruction

Area of Science:

• Oncology
• Plastic Surgery
• Patient-Reported Outcomes

Background:

• Unilateral breast cancer necessitates contralateral breast management choices.
• Options include contralateral prophylactic mastectomy with immediate breast reconstruction (PMIBR) or symmetrization procedures (augmentation, reduction, mastopexy).

Purpose of the Study:

• To compare complications and patient-reported satisfaction between PMIBR and symmetrization for contralateral breast management.
• Evaluate long-term outcomes and well-being in unilateral breast cancer patients.

Main Methods:

• Prospective cohort study over 7 years at a single institution.
• Collected patient-reported BREAST-Q scores at baseline, 3, and 12 months.
• Compared postoperative complications, oncologic outcomes, and satisfaction scores.

Main Results:

• 249 patients: 93 (37%) PMIBR, 156 (63%) symmetrization.
• PMIBR group younger with fewer comorbidities.
• Similar major/minor complication rates, except higher minor wound dehiscence in PMIBR.
• Symmetrization showed a significant decrease in chest physical well-being at 12 months (-5.69 vs. 2.94).
• No significant differences in breast satisfaction or psychosocial well-being.

Conclusions:

• Contralateral breast management (PMIBR or symmetrization) shows similar major complication profiles and good overall satisfaction.
• Symmetrization offers comparable outcomes to PMIBR, potentially avoiding unnecessary prophylactic mastectomy.
• One physical well-being domain differed significantly between the two approaches.