What surgical approach may be considered for patients with LCIS who choose bilateral mastectomy?

For patients with lobular carcinoma in situ (LCIS) who opt for bilateral mastectomy, subcutaneous mastectomy without axillary lymph node dissection is a relevant surgical approach. LCIS is often not associated with invasive disease; thus, it does not typically warrant lymph node assessment since there is no invasive cancer to stage.

In subcutaneous mastectomy, the breast tissue is excised while preserving the skin, which can be especially advantageous for cosmetic outcomes when planned for immediate reconstruction. This approach aligns with the decision-making process for patients with LCIS who are at increased risk for developing breast cancer and therefore choose to undergo prophylactic bilateral mastectomy.

Other surgical options listed, such as axillary lymph node dissection, quadrantectomy, and modified radical mastectomy, involve more invasive procedures or the removal of lymph nodes, which are unnecessary in the context of LCIS alone, where there is no invasive component to justify such interventions.