Assessing the additional surgical risk of contralateral prophylactic mastectomy and immediate breast implant reconstruction

Abstract

Introduction There has been a sharp rise in the rate of contralateral prophylactic mastectomy over the last decade, despite the low incidence of new primary cancers predicted for the contralateral breast. This study compares the postoperative complication rates between the diseased breast treated with mastectomy and the contralateral breast that underwent prophylactic mastectomy, followed by immediate bilateral breast implant reconstruction. We hypothesized that there will be no difference in postoperative outcomes between prophylactic and diseased groups, as the surgical approach would be comparable. Methods After IRB approval, a retrospective chart review identified consecutive unilateral breast cancer patients who underwent bilateral mastectomy and immediate breast reconstruction between May 2008 and May 2018 at a tertiary academic medical center. A paired sample t-test and a penalized logic regression model were constructed to identify relationships between breast laterality and outcomes. Results A total of 1117 patients with unilateral breast cancer who underwent bilateral mastectomy and immediate breast implant reconstruction were identified. Rates of capsular contracture and infection were significantly greater in the diseased breast, while rates of revision were significantly greater in the contralateral prophylactic breast. There were no statistically significant differences between breasts in rates of explant, skin flap necrosis or hematoma. When adjusted for confounding variables, a higher infection rate was observed in the diseased breast. Conclusion This study detected significant differences in postoperative complication rates between the diseased and prophylactic breasts following bilateral mastectomy and immediate breast implant reconstruction. Postoperative complications occurred more frequently in the diseased breast compared with low rates of complications in the contralateral prophylactic breast. This information is helpful for preoperative decision making, as surgeons and patients carefully weigh the additional risks of contralateral prophylactic procedure.

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

“…Prioritization of patients with high-grade cancer may uniformly increase the baseline operative risk of the entire patient cohort, with greater pre-operative morbidity associated with tumor burden and the tendency toward axillary lymph node dissection, which have previously been demonstrated to be independent risk factors for infection [34][35][36]. It is important to consider the relative benefit of immediate implant placement versus primary closure and delayed reconstruction.…”

Is there an increasing trend of risk-reducing prophylactic mastectomy procedure in preventing breast cancer among women?

“…The mean value of tumor size on the right breast was 2.71 ± 1.78 (0.5-5.5) cm, the mean number of the metastatic lymph node on the right axillary was 2.14 ± 0.69 (1)(2)(3). The mean value of tumor size on the left breast was 3.69 ± 2.14 (0.5-7) cm, the mean number of the metastatic lymph node on the left axillary was 5.13 ± 6.94 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The distribution of molecular breast cancer subtypes is shown in Table 2.…”

“…One in every eight women has breast cancer in their life, and one in every 30 women dies due to reasons related to breast cancer (1). There has been a significant increase in the number of risk-reducing PCM/PBM (prophylactic contralateral/prophylactic bilateral mastectomy) globally as it doubled in the last ten years (2).…”

Methods for Quantifying Breast Cancer-Related Lymphedema in Patients Undergoing a Contralateral Prophylactic Mastectomy

“…Women diagnosed with unilateral breast cancer are increasingly opting for a CPM (CPM), even though the incidence of contralateral breast cancer has remained constant over time (19)(20)(21). Patients generally opt for a CPM as it greatly reduces the risk of developing contralateral breast cancer (22)(23)(24).…”