Contralateral Prophylactic Mastectomy: Weighing the Risks of Delayed Chemotherapy, Radiotherapy, and Hormonal Therapy
Averill Clapp*1, Alexander I. Murphy2, Jeffrey A. Ascherman3, Christine Rohde3
1Columbia University Vagelos College of Physicians and Surgeons, New York, NY; 2Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA; 3Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY
Many unilateral breast cancer patients opt for contralateral prophylactic mastectomy (CPM), which may occur at the time of therapeutic mastectomy (“immediate CPM”) or following completion of adjuvant therapy. Studies show that immediate CPM increases the risk of surgical complications relative to unilateral mastectomy (UM) alone, which may lead to delays in adjuvant therapy. However, it remains unclear if these complications cause clinically significant delays in adjuvant therapy. It may be helpful for patients and providers to understand if complications from CPM increase the risk of delays in initiation of adjuvant chemotherapy, radiotherapy, and hormonal therapy.
A retrospective chart review was conducted of all breast cancer patients who underwent immediate CPM or UM alone at Columbia University Medical Center from Jan. 2000–Dec. 2020. Patient demographic characteristics; complications; and timing of initiation of adjuvant chemotherapy, radiotherapy, and/or hormonal therapy relative to index therapeutic mastectomy were collected.
239 UM alone patients were propensity score matched to 239 immediate CPM patients by age at time of therapeutic mastectomy, body mass index, and comorbidities. No significant difference in complications was found between index and contralateral breasts in immediate CPM patients. A similar percentage of CPM and UM alone patients experienced postoperative complications (19.2% vs 17.2%, p = 0.64). No significant difference in time to initiation of adjuvant chemotherapy, radiotherapy, or hormonal therapy was found between CPM and UM alone patients with complications (Table 1).
There is a lack of clear guidance for clinical decision-making regarding timing of CPM relative to adjuvant therapy. Our study suggests that CPM at the time of therapeutic mastectomy does not significantly increase risks of postoperative complications or complication-related delays in initiation of adjuvant chemotherapy, radiotherapy, or hormonal therapy. This information may help patients and providers plan breast cancer treatment options and their timing.
Table 1. Time to adjuvant therapy for immediate CPM and UM alone patients
| CPM patients with complications | UM patients with complications | Two-tailed t-test, CPM patients with complications and UM patients with complications | |
| Mean time to chemotherapy ± SD, days: | 47.8 ± 15.8 (n = 19) | 67.1 ± 41.4 (n = 17) | p = 0.086 |
| Mean time to radiotherapy ± SD, days: | 121.0 ± 78.3 (n = 7) | 119.3 ± 75.9 (n = 10) | p = 0.965 |
| Mean time to hormonal therapy ± SD, days: | 160.6 ± 127.9 (n = 21) | 146.2 ± 130.6 (n = 21) | p = 0.721 |
CPM, contralateral prophylactic mastectomy; UM, unilateral mastectomy; SD, standard deviation
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