[Prophylactic mastectomy and breast reconstruction].

Authors

A Bazeli, E Laas, T Gaillard, L Darrigues, B Couturaud

Published in

Annales de chirurgie plastique et esthetique. Volume 71. Issue 6. Pages 621-628.

Abstract

Contralateral prophylactic mastectomy may be offered to certain patients at high risk of breast cancer, particularly in the presence of germline mutations in BRCA1/2, or other predisposition genes. When a first breast cancer has already been treated with mastectomy and immediate reconstruction, management of the contralateral breast is not solely risk-reducing surgery but also a true reconstruction akin to delayed symmetrization.
The aim of this article is to propose a practical strategy for breast reconstruction after contralateral prophylactic mastectomy in patients who have already undergone unilateral therapeutic mastectomy with immediate reconstruction.
We review the main genetic and oncologic scenarios that justify a prophylactic mastectomy, as well as data on breast risk reduction and the impact on contralateral cancer risk. Reconstructive options are then analyzed according to the type of initial reconstruction of the treated breast: implant-based reconstruction with or without preservation of the nipple-areola complex, implant-based reconstruction with skin envelope adjustment, exclusive lipofilling, latissimus dorsi flap, free DIEP flap, or complex reconstruction in an irradiated setting.
The reconstructive strategy must be individualized based on the initial technique, skin quality, breast volume, prior irradiation, available donor sites, and the patient's preferences. After implant-based reconstruction, a contralateral "mirror" reconstruction may be proposed when anatomic conditions are favorable. In cases of ptosis or hypertrophy, a two-stage approach can reduce the risk of cutaneous or implant-related complications. After autologous reconstruction, the contralateral reconstruction should, whenever possible, favor a solution that reproduces the consistency, mobility, and tissue evolution of the initially reconstructed breast. Complex situations, especially after irradiation, may warrant bilateral conversion to autologous reconstruction to achieve better long-term morphological stability.
Following unilateral immediate breast reconstruction, contralateral prophylactic mastectomy should be considered as delayed symmetrization reconstruction. The objective is not only to restore breast volume after mastectomy, but to achieve bilateral coherence in terms of skin envelope, projection, texture, mobility, and aging. This approach requires personalized counseling, multidisciplinary decision-making, and reconstruction planning tailored to each clinical situation.

PMID:
43014845
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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