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Rationale for elective contralateral mastectomy with immediate bilateral reconstruction

S S Kroll1, M J Miller, M A Schusterman

  • 1Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.

Annals of Surgical Oncology
|November 1, 1994
PubMed
Summary

Bilateral breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flaps offers a high success rate. This approach is a viable option for selected breast cancer patients, minimizing asymmetry risks.

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Area of Science:

  • Oncology
  • Plastic Surgery
  • Reconstructive Surgery

Background:

  • Immediate breast reconstruction following mastectomy can yield excellent results with autogenous tissue.
  • Bilateral reconstruction using transverse rectus abdominis myocutaneous (TRAM) flaps is feasible when performed simultaneously.
  • Some patients opt for bilateral mastectomy with immediate reconstruction to avoid future asymmetrical procedures.

Purpose of the Study:

  • To evaluate reconstructive outcomes in patients undergoing bilateral mastectomy and immediate reconstruction.
  • To assess the success rates of different reconstruction techniques, including TRAM flaps and implants.
  • To analyze histologic findings in prophylactically removed breasts.

Main Methods:

  • Prospective study of 100 breast cancer patients undergoing bilateral mastectomy and reconstruction.

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  • Inclusion of both implant-based and TRAM flap reconstruction methods.
  • Review of histologic findings from 88 prophylactically removed high-risk breasts.

    • Main Results:

    • An overall success rate of 97% was achieved after initial reconstructions and revisions.
    • Bilateral TRAM flap reconstructions demonstrated a high success rate of 98%.
    • TRAM flap reconstructions were significantly more successful than implant-based reconstructions (p = 0.05).

    Conclusions:

    • Bilateral breast reconstruction, especially with TRAM flaps, has a low failure rate.
    • Elective contralateral mastectomy with immediate bilateral reconstruction is a reasonable alternative for selected patients.
    • Patient selection, surgical expertise, and informed consent regarding risks are crucial for successful outcomes.