Chest Port Placement During Bilateral Mastectomy
Yes, subcutaneous chest port placement can be safely performed concurrently with bilateral mastectomy, but alternative anatomical sites—particularly the mid-axillary line or upper arm—should be strongly considered to preserve cosmetic outcomes and avoid additional chest wall scarring. 1, 2
Primary Recommendation: Consider Alternative Port Sites
The optimal approach is to place the port in the mid-axillary line at the anterior border of the latissimus muscle or in the upper arm (mid-arm position) rather than the traditional anterior chest wall location. 1, 2, 3
Rationale for Alternative Sites:
Cosmetic preservation: In an era where bilateral mastectomy techniques (including nipple-sparing approaches) achieve excellent aesthetic results, placing a port on the anterior chest wall creates an additional disfiguring scar that undermines the cosmetic benefit of modern breast surgery 2
Body image impact: Negative body image perception significantly affects physical and psychological wellbeing of breast cancer survivors, and it is counterproductive to perform meticulous breast reconstruction only to mar the upper chest with port-related scarring 2
Equivalent safety profile: Axillary/mid-arm port placement demonstrates complication rates (9-10%) that are statistically equivalent to traditional chest wall placement (13%), with no significant difference in infection, thrombosis, or catheter-related problems 1, 3
Technical feasibility after bilateral surgery: Multiple anatomical sites remain available even after bilateral mastectomy, including paramedian chest wall (if necessary), anterolateral chest wall, trapezius muscle region, mid-axillary line, and antecubital fossa 1
If Chest Wall Placement Is Necessary
When anatomical constraints or patient factors mandate chest wall placement:
Paramedian positioning (3 patients in one series) can be used as an alternative to the standard anterolateral chest wall approach 1
Careful anatomical assessment is essential—the extent of bilateral breast surgery dictates which chest wall locations remain viable 1
Patient involvement in the decision-making process regarding port location improves satisfaction and compliance 1
Timing Considerations
Port placement can be performed concurrently with mastectomy or as a staged procedure (mean interval of 34 months in one series, range 1-84 months) 1
There is no evidence suggesting that concurrent placement increases surgical complications, though this decision should account for operative time, patient tolerance, and reconstruction complexity
Technical Execution
Internal jugular vein access is preferred when placing axillary ports (82% of cases vs. 56% for chest wall ports) 3
Interventional radiology suite placement is a safe alternative to operating room placement, with procedure-related complication rates of 0% and infection rates as low as 0.19/1000 catheter days 1
Mean follow-up data (15-39 months) demonstrate sustained safety and function regardless of anatomical site 1
Critical Pitfalls to Avoid
Do not default to anterior chest wall placement simply because it is traditional—this represents a missed opportunity to preserve cosmetic outcomes in patients who have already undergone significant body-altering surgery 2
Do not place ports without discussing location options with the patient, particularly in younger women or those undergoing nipple-sparing mastectomy with immediate reconstruction 2
Avoid the neckline and upper chest in most cases to optimize patient-related outcomes and body image satisfaction 2
Do not assume bilateral mastectomy precludes axillary placement—careful patient and anatomical selection allows safe alternative site utilization 1
Patient Education Requirements
Explain cosmetic implications of each port location option before surgery 2
Discuss potential complications specific to each anatomical site (infection, thrombosis, catheter malfunction) 1, 3
Set realistic expectations regarding port visibility, clothing considerations, and long-term aesthetic impact 2
Emphasize the importance of follow-up and early reporting of port-related symptoms 1
Evidence Quality Note
The available evidence consists primarily of retrospective case series 1, 3 and case reports 2 rather than randomized trials. However, the consistent finding across multiple studies is that alternative port sites (axillary, mid-arm) offer equivalent safety with superior cosmetic outcomes compared to traditional chest wall placement in bilateral mastectomy patients.