Bilateral Breast Reconstruction

(Bilateral mastectomies and reconstructions)

With the increasing incidence of breast cancer, development of screening programmes, knowledge of genetic risk factors and patient awareness, bilateral mastectomies are increasingly performed. There are a number of indications for bilateral mastectomies which include bilateral breast cancer, unilateral breast cancer with contralateral mastectomy for prophylaxis or premalignant disease, and bilateral prophylactic mastectomies. Thus, a significant number of women requiring bilateral breast reconstructions consult plastic surgeons each year. Bilateral reconstructions may also be required to revise previous unsatisfactory reconstructions.

In tandem with increased awareness of breast cancer there is a growing public knowledge of breast reconstruction options. Many women have encountered someone who has undergone breast reconstruction or have informed themselves from magazines, books or the Internet. The aim of reconstructive surgery is not merely to recreate the breast mound but also to achieve symmetrical, soft, aesthetically-pleasing breasts. This is particularly important in younger mastectomy patients with a good long-term prognosis, who may not wish to have implant reconstruction, knowing the risk of developing complications over decades. Suitable patients often prefer to have their reconstruction performed at the time of mastectomy - which has been shown to have both psychological and aesthetic benefits. However, bilateral breast reconstructions can be major, labour-intensive procedures with prolonged recovery times, especially when they incorporate bilateral mastectomies and two free tissue transfer operations in a single session. In addition to implications for the patient, these operations have financial consequences for the hospital involved. Bilateral reconstructions can be immediate when the mastectomies are being performed at the same time, both delayed when the mastectomies were performed months or years before or delayed and immediate when a unilateral mastectomy is being done one side in a patient who has previously undergone a mastectomy on the opposite side.

Indications for bilateral breast reconstructions

• Bilateral prophylactic mastectomy

• Bilateral breast cancers at the same time (very rare)

• Unilateral curative mastectomy for cancer + prophylactic mastectomy on opposite breast

• Previous bilateral mastectomies

• Previous unilateral curative mastectomy now seeking prophylactic mastectomy on opposite breast and reconstruction

• Previous unilateral curative mastectomy now has breast cancer on opposite side needing curative mastectomy

To view the before and after photos in some of Professor Malata’s publications on bilateral breast reconstruction please click here

• (Resource Implications of Bilateral Autologous Breast Reconstruction – A Single Centre’s Six Year Experience;

• Influence of neoadjuvant chemotherapy on outcomes of immediate breast reconstruction;

• Cowden syndrome and reconstructive breast surgery - Case reports & review of the literature;

• Experience with Mentor Contour Profile Becker-35 expanders in reconstructive breast surgery)

As in any surgery, there are benefits, risks and the final results are not guaranteed. The chance of complications following bilateral breast reconstruction depends on the type of operation and other factors such as your general health. Professor Malata will explain how the risks apply to you. Detailed postoperative instructions will be discussed during consultation and a procedure-specific handout given to you by Professor Malata.