Complications Associated with Contralateral Prophylactic Mastectomy: A Systematic Review and Pooled Analysis
Alexander I. Murphy1, Paul A Asadourian1, Joseph A Mellia2, Christine H Rohde1
1Columbia University, New York City, NY; 2Stony Brook University, Stony Brook, NY
BACKGROUND: Unilateral breast cancer patients may be offered unilateral mastectomy (UM) with or without contralateral prophylactic mastectomy (CPM). Understanding the additional complication risk of CPM is important for patients considering these treatment options. A systematic review and pooled analysis of studies on complications associated CPM could be useful for informing discussions of this additional risk.
METHODS: In February 2021, a systematic search identified 15 studies that met inclusion criteria. Basic study characteristics were collected and Newcastle-Ottawa quality-of-study score was assigned to each article. Data was pooled to compare complication rates in 1) diseased versus CPM breasts of UM+CPM patients and 2) patients undergoing UM+CPM versus UM alone. Outcomes included incidence of any complication and any severe complication requiring re-operation, re-admission, or delay in adjuvant therapy. Fisher’s exact and Chi square tests were used for statistical comparisons, and P0.9999) between UM+CPM versus UM alone patients. These groups also had no significant difference in incidence of complication-related delay in adjuvant therapy (1 study, RR: 3.25, CI: 0.57-19.48, p=0.3064), although this was only measured in one study.
CONCLUSIONS: Both breasts undergo complications after UM+CPM, but incidence is higher in the diseased breast. Although some studies show similar complication rates for UM+CPM versus UM alone, evidence including the field’s highest-quality study supports a greater incidence of complications and complication-related reoperation and/or readmission after UM+CPM. Future studies may be needed to determine if the elevated complication rate of UM+CPM leads to delayed adjuvant therapy for breast cancer patients.
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