In general, a contralateral prophylactic mastectomy (CPM) does not improve the patient’s overall survival. In addition, a woman can have recurrent breast cancer even after prophylactic mastectomy.
Patient selection: breast cancer with no evidence of tumor in the contralateral breast
Reasons for considering CPM.
(1) high risk for breast cancer (BRCA, etc)
(2) can be performed at same operation as resection of the affected breast
(3) failure of previous breast conserving management to prevent recurrence
(4) anxiety about cancer recurrence
(5) prolonged period without adequate medical followup
(6) better cosmesis with immediate reconstruction
(7) difficult to exam breasts (severe fibrocystic disease, etc)
Reasons against CPM
(1) separate surgery required
(2) effective risk reduction through irradiation and/or chemotherapy
(3) adequate followup
