Contralateral Mastectomy Decisions — Your Professional Perspective

Dear Colleagues,

As the Medical Director, I am reaching out to you today to seek your expert input regarding a matter that has been on my mind. Despite many years in practice and a solid foundation in medical knowledge, I find myself troubled by the course of treatment my sister received for her breast cancer, as well as the broader implications for breast cancer care.

My sister, 77 years old, was diagnosed with stage 2 left breast cancer in 2015. She underwent a lumpectomy, followed by radiation therapy, chemotherapy with strong agents, and five years of hormone therapy. Fast forward ten years, and she now has a new cancer in the contralateral breast.

What stands out in this case is that my sister, a highly educated individual with a Master's degree in nursing, had requested bilateral mastectomies at the time of her initial diagnosis. However, her surgeon advised her that a lumpectomy was sufficient, and she was counseled that the contralateral breast did not require surgery. At the time, Medicare covered surgery for the contralateral breast for symmetry purposes, as well as bilateral reconstruction for the same reason. Despite her request, the decision was made not to proceed with a bilateral mastectomy.

This situation has prompted me to examine the broader question of treatment options for the contralateral breast in cases like this. My wife, for example, was 67 when she underwent bilateral mastectomies for breast cancer, a decision she made independently, even though the contralateral breast did not show signs of cancer. Similarly, my niece, aged 43, diagnosed with breast cancer, opted for bilateral mastectomies as a preventive measure to reduce her risk of cancer recurrence in the remaining breast.

I would greatly appreciate your insights and experience on this matter, specifically regarding the role of bilateral mastectomies and the management of the contralateral breast in breast cancer patients. I am compiling your responses and will share the findings in a blog post, which will be published in The Wound Vac Company newsletter, as well as potentially in popular women's health magazines.

Please take a moment to answer the following questions with a simple "Yes" or "No," and reply to this email at your earliest convenience:

After mastectomy for breast cancer, do you agree that something should be done to address the remaining breast?

☐ Yes ☐ No

Do you believe there is a possibility that cancer could occur in the remaining breast?

☐ Yes ☐ No

Do you discuss the option of removing the remaining breast with patients?

☐ Yes ☐ No

Feel free to include any additional comments or thoughts you may have. I am deeply concerned that my sister was not presented with the option of a bilateral mastectomy in 2015, and I am eager to understand how common this practice is in our field.

Thank you for taking the time to respond to this important inquiry.