Prophylactic Mastectomy: Who Benefits

Over the last 20 years, the rates of prophylactic mastectomy (PM) have increased significantly, but there are limited populations who derive benefit. This paper reviews indications for contralateral prophylactic mastectomies (CPM) and bilateral risk-reducing mastectomies (BRRM), important factors to discuss with patients, and complications of the procedure. It concludes with a brief review of contraindications. PM does not confer a survival benefit in normal risk patients or most patients with genetic mutations. Indications for CPM or BRRM include pathogenic mutations and a history of chest wall radiation. Situations in which patients might benefit include those with > 25% lifetime risk of breast cancer. CPM is not routinely arecommended for normal risk patients with a unilateral cancer as the risk of contralateral breast cancer is low. A thorough discussion of surgical risks, oncologic risks, aesthetic outcomes, quality of life, and psychosocial factors is essential.