Is it worth the risk? Contralateral prophylactic mastectomy with immediate bilateral breast reconstruction
Tara M. Chadab, MD MS1, Jaime L. Bernstein, MD MS1, Andrea Lifrieri, BS2, Jeffrey A. Ascherman, MD3, Robert T. Grant, MD MS1, Christine H. Rohde, MD MPH3.
1New York Presbyterian- Cornell & Columbia University Hospitals, New York, NY, USA, 2Columbia University Medical School, New York, NY, USA, 3New York Presbyterian- Columbia University Medical Center, New York, NY, USA.
BACKGROUND: An increasing number of women are choosing to undergo contralateral prophylactic mastectomy with immediate bilateral breast reconstruction. Operating on the contralateral noncancer side is not without its own set of risks. We sought to compare complication rates between the cancerous and contralateral prophylactic breasts.
METHODS: A retrospective review was conducted of all patients undergoing immediate postmastectomy bilateral breast reconstruction for unilateral breast cancer between January 2008 and January 2019 at a single institution. Data was collected on patient demographics, cancer and adjuvant/neoadjuvant treatments, tumor, reconstruction, hospital stay, and complications. Outcomes were compared between the cancerous and the noncancerous breasts.
RESULTS: 160 patients met the inclusion criteria of this study. Of these 160 patients, 31 patients (19.4%) had complications (major and minor) only to the cancerous breast, 8 patients (5.0%) had complications only to the noncancerous breast, and 7 patients (4.4%) had bilateral complications. The majority of patients underwent tissue expander/implant reconstruction (93.8%) with the rest (6.2%) undergoing abdominally-based flap or latissimus dorsi flap reconstruction. Patients with complications were more likely to have hypertension, diabetes, exposure to radiation and neoadjuvant chemotherapy. Complications included wound dehiscence, hematoma, cellulitis, seroma, capsular contracture, infected implant, and skin necrosis. Overall, there were significantly more complications to the cancerous breast than the non-cancerous breast (p<0.001); however, there was no significant difference between the two groups when stratified by specific complications. Additionally, while exposure to radiation to the affected side significantly increased the likelihood of complications to that side (p=0.018), patients who were not exposed to any radiation were also more likely to have complications to the cancer side than to the prophylactic side (p<0.001).
CONCLUSIONS: While contralateral prophylactic mastectomy with immediate bilateral reconstruction is not without added risk when compared to a unilateral procedure, this study shows that the incidence of complications to the noncancerous breast is less than that to cancerous breast. This information can be used to help counsel patients with unilateral breast cancer on their treatment options and associated risks.
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