The relationship between contralateral prophylactic mastectomy and breast reconstruction, complications, breast-related procedures, and costs: A population-based study of health insurance data

Schroeder, Mary C.; Tien, Yu-Yu; Erdahl, Lillian M.; Lizarraga, Ingrid M.; Viyyuri, Brahmendra Reddy; Sugg, Sonia L.

doi:10.1016/j.surg.2020.06.030

Cited by 11 publications

(16 citation statements)

References 44 publications

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“…Contralateral prophylactic mastectomy may therefore be viewed by the laywoman as an acceptable treatment for unilateral breast cancer because it is financially covered. Although there is little cost to patients, there are increased costs to the health care system, including managing complications, additional breast-related procedures, and lost productivity …”

Section: Funding Of Contralateral Prophylactic Mastectomiesmentioning

confidence: 99%

Bilateral Mastectomy in Women With Unilateral Breast Cancer

2021

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Section: Funding Of Contralateral Prophylactic Mastectomiesmentioning

confidence: 99%

Bilateral Mastectomy in Women With Unilateral Breast Cancer

2021

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“…Second, prior studies have used alternative inclusion or exclusion criteria for UBC patients, such as exclusion of patients who did not meet certain histological and staging requirements, 5 inclusion of patients exclusively in the State of New York, 34 or exclusion of patients whose tumor size did not meet certain metrics or who were diagnosed through an excisional biopsy. 18…”

Section: Discussionmentioning

confidence: 99%

“…First, the population samples are different and, as described above, our sample had a disproportionate representation of White patients residing in certain geographic locations in the United States. Second, prior studies have used alternative inclusion or exclusion criteria for UBC patients, such as exclusion of patients who did not meet certain histological and staging requirements, 5 inclusion of patients exclusively in the State of New York, 34 or exclusion of patients whose tumor size did not meet certain metrics or who were diagnosed through an excisional biopsy. 18…”

Section: Discussionmentioning

confidence: 99%

Nationwide Trends in Contralateral Prophylactic Mastectomies: An Analysis of 55,060 Unilateral Breast Cancer Patients

Shaheen

Momeni

2022

Plastic and Reconstructive Surgery - Global Open

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Background: The effects of recent initiatives to better educate unilateral breast cancer (UBC) patients about contralateral prophylactic mastectomy (CPM) have not been fully examined. The purpose of this study was to update and examine recent annual CPM trends by evaluating 2015–2020 data from a large administrative claims database. We also sought to determine if there were any variations in trends among different age groups and reconstructive modalities. Methods: Patients diagnosed with UBC between 2015 and 2019 were identified in Optum Clinformatics DataMart. Patients were then categorized by age group, whether they underwent CPM, whether they underwent breast reconstruction (BR), timing of any BR (immediate or delayed), and type of BR (implant-based or autologous). Results: Of 55,060 patients who were diagnosed with UBC, 2625 (4.8%) underwent CPM. After a slight decline from 2015 to 2016, the CPM rate among UBC patients increased significantly from 3.4% in 2016 to 6.8% in 2019. Although this upward trend remained consistent across all age groups examined, younger UBC patients represented a significantly higher and faster growing percentage of those undergoing CPM. BR rates among those who underwent CPM also increased between 2015 and 2019, with implant-based and immediate BR becoming more heavily favored over autologous and delayed BR. Conclusions: CPM rates continued to rise between 2016 and 2019 and younger women represented a substantially higher and faster growing percentage of UBC patients undergoing CPM than older women. In addition, implant-based and immediate BR are becoming more heavily favored over autologous and delayed BR.

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“…Most women who elect to undergo contralateral prophylactic mastectomy are young, White, with higher income, and education level. These women are also more likely to elect for implant-based reconstruction 5,6,8 . The studies that compare women undergoing unilateral to bilateral mastectomy fail to account for the self-selection that has occurred.…”

mentioning

confidence: 99%

“…4 Studies aimed to identify postoperative complications of prophylactic contralateral mastectomy have been contradictory. While some studies argue that bilateral mastectomy has higher complication and reoperation rates, 5,7,8 others claim that the complication rates for unilateral mastectomy are similar to that of bilateral mastectomy. 6,[9][10][11] One of the major flaws in these studies has been that the comparison groups have not been comparable in terms of demographics.…”

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confidence: 99%

Comparing Outcomes in the Therapeutic and Prophylactic Breast for Bilateral Mastectomy With Implant-Based Breast Reconstruction

et al. 2023

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BackgroundIncreasingly patients with unilateral breast cancer elect to undergo bilateral mastectomy with subsequent reconstruction. Studies have aimed to better identify the risks associated with performing mastectomy on the noncancerous breast. Our study aims to identify differences in complications between therapeutic and prophylactic mastectomy in patients undergoing implant-based breast reconstruction.MethodsA retrospective analysis of implant-based breast reconstruction from 2015 to 2020 at our institution was completed. Patients with less than 6-month follow-up after final implant placement had reconstruction using autologous flaps, expander or implant rupture, metastatic disease requiring device removal, or death before completion of reconstruction were excluded. McNemar test identified differences in incidence of complications for therapeutic and prophylactic breasts.ResultsAfter analysis of 215 patients, we observed no significant difference in incidence of infection, ischemia, or hematoma between the therapeutic and prophylactic sides. Therapeutic mastectomies had higher odds of seroma formation (P = 0.03; odds ratio, 3.500; 95% confidence interval, 1.099–14.603). Radiation treatment status was analyzed for patients with seroma; 14% of patients unilateral seroma of the therapeutic side underwent radiation (2 of 14), compared with 25% patients with unilateral seroma of the prophylactic side (1 of 4).ConclusionsFor patients undergoing mastectomy with implant-based reconstruction, the therapeutic mastectomy side has an increased risk of seroma formation.

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The relationship between contralateral prophylactic mastectomy and breast reconstruction, complications, breast-related procedures, and costs: A population-based study of health insurance data

Cited by 11 publications

References 44 publications

Bilateral Mastectomy in Women With Unilateral Breast Cancer

Bilateral Mastectomy in Women With Unilateral Breast Cancer

Nationwide Trends in Contralateral Prophylactic Mastectomies: An Analysis of 55,060 Unilateral Breast Cancer Patients

Comparing Outcomes in the Therapeutic and Prophylactic Breast for Bilateral Mastectomy With Implant-Based Breast Reconstruction

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