Rates and Complications of Prophylactic Breast Reconstruction
Kanad Ghosh, BA1, Jocellie Marquez, MD, MBA2, Sara Kianian, BA, MTM1, Hunter Rogoff, BS1, Kaitlin Monroig, BA1, William Marmor, BS1, Phoebe McAuliffe, BA1, Tara L. Huston, MD2, FACS, Sami U. Khan, MD, FACS2, Duc T. Bui, MD2
1Stony Brook University School of Medicine, Stony Brook, NY; 2Stony Brook University Hospital Division of Plastic Surgery, Stony Brook, NY
Background: Patients undergoing mastectomy and reconstruction for breast cancer often elect to undergo prophylactic mastectomy of the contralateral breast. However, patients should be advised regarding the complication rates of prophylactic mastectomy and reconstruction. In this study, we examine the rate of tissue-expander and autologous prophylactic reconstruction at our institution. We further compare complication rates between therapeutic reconstructions performed on cancer afflicted breasts and prophylactic reconstructions.
Methods: A retrospective review was conducted on patients undergoing immediate breast reconstruction via tissue expanders or autologous methods from 2010 – 2017. Subgroup analysis was conducted among patients with bilateral reconstruction, with one side therapeutic reconstruction and the other side prophylactic reconstruction, in order to provide an internal control. Patients with history of post-operative radiation were excluded from this subgroup due to increased risk placed on the therapeutic breast.
Results: 1,080 breast reconstructions were initially examined over the included time period. The proportion of prophylactic reconstruction was 42.7% and the proportion of therapeutic mastectomy was 57.3%. When broken down by year, prophylactic reconstruction rates ranged from 34.4% to 50.8%, with a peak in 2014. Therapeutic reconstruction rates ranged from 49.2% to 65.6% with a peak in 2011. The mean age of patients undergoing prophylactic reconstruction was significantly younger than patients undergoing therapeutic reconstruction only (48.80 ± 10.36 vs 54.66 ± 11.84, p<.001). Of the total study population, 229 patients (458 breasts) underwent bilateral reconstruction with one therapeutic and one prophylactic side. 408 breasts were reconstructed using tissue expanders (Group-TE). Among this group, the number of complications did not differ between therapeutic and prophylactic breasts. Similarly, the occurrence of complication, infection, implant loss, hematoma, capsular contracture, skin necrosis, and wound dehiscence were not significantly different between therapeutic and prophylactic breasts. There was an increased incidence of seroma among therapeutic breasts that approached significance (2.9% vs 0.5%, p=.057). Of the subgroup population of 229 patients, 25 patients (50 breasts) underwent bilateral autologous reconstruction with one therapeutic and one prophylactic side (Group-AR). There was no difference in the number of complications between therapeutic and prophylactic breasts. The occurrence of complication, infection, hematoma, skin necrosis, venous congestion, arterial thrombosis, and flap failure were not significantly different between therapeutic and prophylactic breasts.
Conclusion: Our data reveals that a large portion (42.7%) of breast reconstructions were prophylactic. Prophylactic reconstruction has similar complication rates to therapeutic reconstruction. Patients should be advised of these complication rates if they choose to undergo a prophylactic reconstruction.
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