Indications for Contralateral Prophylactic Mastectomy: A Consensus Statement Using Modified Delphi Methodology

Ann Surg. 2018 Feb;267(2):271-279. doi: 10.1097/SLA.0000000000002309.


Objective: To reach a consensus about contralateral prophylactic mastectomy in unilateral breast cancer.

Summary background data: There has been a substantial increase in the number of North American women with unilateral breast cancer undergoing a therapeutic mastectomy and a contralateral prophylactic mastectomy (CPM) either simultaneously or sequentially. The purpose of this project was to create a nationally endorsed consensus statement for CPM in women with unilateral breast cancer using modified Delphi consensus methodology.

Methods: A nationally representative expert panel of 19 general surgeons, 2 plastic surgeons, 2 medical oncologists, 2 radiation oncologists, and 1 psychologist was invited to participate in the generation of a consensus statement. Thirty-nine statements were created in 5 topic domains: predisposing risk factors for breast cancer, tumor factors, reconstruction/symmetry issues, patient factors, and miscellaneous factors. Panelists were asked to rate statements on a 7-point Likert scale. Two electronic rounds of iterative rating and feedback were anonymously completed, followed by an in-person meeting. Consensus was reached when there was at least 80% agreement.

Results: Our panelists did not recommend for average risk women with unilateral breast cancer. The panel recommended CPM for women with a unilateral breast cancer and previous Mantle field radiation or a BrCa1/2 gene mutation. The panel agreed that CPM could be considered by the surgeon on an individual basis for: women with unilateral breast cancer and a genetic mutation in the CHEK2/PTEN/p53/PALB2/CDH1 gene, and in women who may have significant difficulty achieving symmetry after unilateral mastectomy.

Conclusion: Contralateral prophylactic mastectomy is rarely recommended for women with unilateral breast cancer.

Publication types

  • Consensus Development Conference
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers, Tumor / genetics
  • Breast Neoplasms / genetics
  • Breast Neoplasms / prevention & control*
  • Carcinoma, Lobular / genetics
  • Carcinoma, Lobular / prevention & control
  • Clinical Decision-Making
  • Delphi Technique
  • Female
  • Humans
  • Prophylactic Mastectomy*
  • Risk Assessment


  • Biomarkers, Tumor