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Simultaneous contralateral prophylactic mastectomy compared to unilateral nipple-sparing mastectomy for breast cancer surgical treatment: Are complications higher?

Published:December 06, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.12.007

      Highlights

      • Prophylactic mastectomy can be performed in patients with unilateral. breast cancer without compromise of oncological treatment.
      • Obesity and active smoking are predictors for mastectomy complications.
      • Detailed discussions between surgeons and patients for the decision of undergoing CPM is imperative.

      Abstract

      Background

      This study compared post-operative reconstructive complications and oncologic treatment between patients who underwent unilateral versus bilateral nipple sparing mastectomy (NSM) with implant based reconstruction (IBR).

      Methods

      Patients diagnosed with unilateral breast cancer who underwent NSM with IBR between 2010 and 2019 were reviewed. Patient demographics, surgical details, adjuvant therapy and postoperative complications were analyzed.

      Results

      A total of 434 NSM with IBR were performed in 269 patients, 24% unilateral, and 76% bilateral. The bilateral group received a direct implant significantly more frequently and were younger compared to unilateral (p < 0.001). The unilateral group received post-mastectomy radiation therapy at significantly higher rate (p < 0.001) with no difference in receipt of adjuvant chemotherapy.
      Overall, 11% of mastectomies developed a 30-day complication requiring reoperation and that extended to 13% at 120 days. There was no difference regarding the incidence of complications requiring reoperation (p = 0.84) or complications type between the two groups (p = 0.29).

      Conclusion

      These findings support the oncologic and reconstructive equivalence to support patient choice in CPM.

      Keywords

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