SYNCHRONOUS, BILATERAL MASTECTOMY

Sixty-four patients (mean age, 51 years) had mastectomies which were s ynchronous and bilateral. Sixty-one premastectomy biopsies (bilateral, 34 and unilateral, 27) demonstrated the following: invasive carcinoma , 17; noninvasive carcinoma, 24; combination of above, 10; and benign disease, 10. Twenty-two patients had bilateral mastectomy because of b ilateral positive biopsy. Twenty-nine patients with unilateral carcino ma on biopsy had bilateral mastectomy. Thirteen patients had bilateral mastectomy despite benign disease only on biopsy (10) or no biopsy (3 ). Ten unexpected carcinomas (34%) were found in the contralateral bre ast in the 29 patients with carcinoma diagnosed on unilateral biopsy. The biopsy pathology of these 10 specimens was invasive ductal carcino ma in 1 and multifocal, noninvasive carcinoma (ductal, 3 and lobular, 6) in 9. An unexpected carcinoma may be found in the contralateral bre ast in a significant number of patients who are selected for bilateral mastectomy, particularly if the selection is on the basis of a noninv asive, lobular histology. Bilateral mastectomy may be appropriate for such patients, particularly when complicated by a strong family histor y and breasts which are difficult to assess by physical or mammographi c examination. (C) 1995 Wiley-Liss, Inc.