This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
This analysis of 15 studies included almost 2,000 women with cancer in one breast who had both breasts removed to give them a symmetrical, flat chest. The analysis found that women who had both breasts removed:
- overall, were satisfied with their decision
- had fewer complications than women who had breast reconstruction
- had slightly more complications than women who had one breast removed.
The results will inform discussions between clinicians and women about the benefits and risks of this surgery.
More information on mastectomy is available on the NHS website.
The issue: what are the surgical options for women with cancer in one breast?
Each year, approximately 56,000 women in the UK are newly diagnosed with breast cancer. Some 1 in 4 will have the affected breast(s) surgically removed (mastectomy).
Women who have had one breast removed because of cancer may choose to have no further surgery; they may use a prosthesis in the bra to appear symmetrical. Others opt to have breast reconstruction using implants or their own tissue to recreate a breast mound.
Some women want their second breast removed to leave their chest symmetrical and flat. This option is not currently recommended in guidelines, and is not often offered by doctors. Women may therefore have to navigate complex clinical pathways to have this surgery. Doctors may be reluctant to offer it because there is no breast cancer-related benefit, and the surgery itself carries risks. Some may be concerned that women will regret their decision over time.
This study investigated the medical outcomes of choosing to have both breasts removed (for non-medical reasons) without breast reconstruction and how women felt about their decision.
What’s new?
The researchers analysed 15 studies (from 2000 – 2022) involving women with cancer in one breast. Overall, the review included 1,954 women who had both breasts removed without reconstruction. The studies asked similar but not identical questions.
The results suggested that, overall, women who had both breasts removed were:
- generally satisfied with their choice (74% satisfied in one study, 10% regretted the decision in another study; satisfaction similar to that for reconstruction in a third study)
- more likely to have complications than women who had 1 breast removed (up to 2 times more likely in some studies; others suggested complications were similarly likely)
- at lower risk of complications (7 – 43%) than those who had reconstruction (29 – 50%).
Women who had both breasts removed were more likely to be highly satisfied with their experience when they received adequate information on surgical options, and had their care provided by a specialist breast surgeon. Women were more likely to regret their choice of surgery if they had a complication particularly if this required readmission to hospital or further surgery.
There was some evidence that women who had breast reconstruction were more satisfied with their sex lives (including self-confidence and sense of attractiveness) after surgery than those who did not, though results were mixed.
Many women were not offered the option to have both breasts removed. Even when they were, one study found that some (21%) felt their doctor did not support their decision. Women reported that they wanted enough tissue removed to give them a flat chest and they were not satisfied if tissue was left. Some said surgeons assumed their gender identity, and expected that they would want reconstruction.
Why is this important?
The findings will allow women to make informed decisions about what surgery to choose after treatment for breast cancer. The results could increase doctors’ confidence about discussing and performing double mastectomies in this group of women.
The researchers hope the findings will help doctors appreciate some women’s desire to have both breasts removed to achieve ‘flat symmetry’ and encourage doctors to remove barriers. Women considering this option need better support and information, the researchers say.
What’s next?
The lead author is carrying out further research to inform future guidelines and a clinical pathway for double breast removal without reconstruction. The aim is to reduce unequal access to care, and encourage services throughout the NHS to fund this surgery. Long-term data on both patient and clinical outcomes is needed.
The researchers suggest doctors would benefit from training on how to discuss this surgery with women, and from a greater awareness of why women choose this option. Many clinicians assumed women wanted to prevent further cancer, but women said it was for aesthetic and practical reasons.
You may be interested to read
This is a summary of: Griffin C, and others. Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review. Annals of Surgical Oncology 2024; 31: 303 – 315.
Flat Friends UK, a charity that supports people who have had a mastectomy.
Breast Cancer Now’s expert nurses will discuss your breast cancer treatment with you via their free helpline: 0808 800 6000. Information on breast cancer surgery and after care are also available.
Information on taking part in NIHR research on breast cancer.
Funding: Shelley Potter is an NIHR Clinician Scientist and Katherine Fairhurst is an NIHR Academic Clinical Lecturer.
Conflicts of Interest: None declared.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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