Variation in practice and provision of contralateral symmetrising mastectomy after unilateral mastectomy for breast cancer: A UK national practice survey

INTRODUCTION: Contralateral symmetrising mastectomy (CSM) may be a good alternative to breast reconstruction for some women following a single mastectomy for breast cancer, but women report challenges accessing care. We explored the current practice and provision of CSM as an alternative to breast reconstruction in the UK. METHODS: An online survey was developed to explore current pathways for women seeking CSM and the information and support provided. The survey was circulated via social media and the UK professional associations, July 2023-May 2024. One survey was completed per unit. Descriptive statistics were used to summarise the results. Content analysis was used for free text. RESULTS: 51 units participated in the survey. Of these, only 28% (n = 14) reported having a formalised pathway for women seeking CSM. Pathways varied in their requirements for multidisciplinary team discussions, psychology and/or plastic surgery referral and/or inclusion of a 'cooling off' period, but most had been developed exclusively by breast surgeons with little multidisciplinary involvement. None of the pathways had been developed with patients. Units without pathways reported managing patients on a case-by-case basis. Most units did not have a formal 'cooling off' period between index mastectomy and CSM but two-thirds would not perform the procedures at the same time as the therapeutic mastectomy. Over 70% (n = 36) only discussed CSM if this was specifically raised by the patient. CONCLUSION: There is significant variation in the practice and provision of CSM in the UK. Consensus-based guidelines are needed to support equitable and appropriate access to care.