AUTHOR=Lopez Christopher D. , Bluebond-Langner Rachel , Houssock Carrie A. , Slezak Sheri S. , Bellavance Emily 

TITLE=Plastic and Reconstructive Surgeons' Knowledge and Comfort of Contralateral Prophylactic Mastectomy: A Survey of the American Society of Plastic Surgeons

JOURNAL=Frontiers in Oncology

VOLUME=Volume 8 - 2018

YEAR=2019

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2018.00647

DOI=10.3389/fonc.2018.00647

ISSN=2234-943X

ABSTRACT=Background:  Despite limited oncologic benefit, contralateral prophylactic mastectomy (CPM) rates have increased in the United States over the past 15 years. CPM is often accompanied by breast reconstruction, requiring input from both breast and plastic surgeons. Little is known about plastic surgeons’ (PS) perspectives of CPM. The purpose of this study was to assess PS practice patterns, knowledge of CPM oncologic benefits, and perceptions of the CPM decision-making process. 

Methods: An electronic survey was sent to 2642 members of the American Society of Plastic Surgeons (ASPS). Questions assessed demographics, practice patterns, knowledge of CPM oncologic benefits, and perceptions of the CPM decision-making process. 

Results: ASPS response rate was 12.5% (n=329). Most responders worked in private practice (69%), were male (81%) practiced for ≥ 15 years (60%). The median number of CPM reconstructions performed per month was 2-4. Responders reported CPM discussion was most likely to be initiated by the patient (51%) followed by the breast surgeon (38%), and plastic surgeon (7.3%). According to PS, the most common reason patients choose CPM is a perceived increased contralateral cancer risk (86%). Most plastic surgeons (63%) assessed the benefits of CPM as worth the risk of additional surgery and 53% estimated the complication rate at 2X the risk of unilateral surgery. The majority (61%) of PS estimated risk of contralateral cancer in an average risk patient between <2%-5% over 10 years. Eighty-seven percent reported that there was no or limited evidence for breast cancer specific survival benefit with CPM. Only 18.5% reported discomfort with a patient’s choice for CPM. The most common reasons for PS discomfort were a concern with the risk/benefit ratio of CPM and  lack of patient understanding of expected outcomes. 

Discussion: To our knowledge, this is the first survey reporting PS perspectives on CPM. According to PS, CPM dialogue appears to be patient driven and dominated by a perceived increased risk of contralateral cancer. Few PS reported discomfort with CPM. Most PS acknowledge the limited oncologic benefit of CPM and  increased risk complication risk. However, the majority have the opinion that the benefits of CPM are worth the additional risk.