S. R. DeBiase1, W. Sun2, C. Laronga2, D. Boulware3, J. K. Lee3, M. Lee2 1University Of South Florida College Of Medicine,Tampa, FL, USA 2Moffitt Cancer Center And Research Institute,Moffitt Breast Program,Tampa, FL, USA 3Moffitt Cancer Center And Research Institute,Moffitt Biostatistics,Tampa, FL, USA
Introduction: Despite recommendations against routine use, contralateral prophylactic mastectomy (CPM) at the time of unilateral breast cancer (BC) surgery is increasing. CPM has been associated with increased immediate complication rates comparative to unilateral mastectomy (UM) with or without reconstruction. We reviewed BC patients receiving mastectomy and immediate reconstruction; our aim was to evaluate complication rates in patients receiving CPM versus UM.
Methods: An IRB approved, retrospective, case-controlled, single-institution chart review of BC patients receiving mastectomy and immediate reconstruction from Jan 1990 – May 2013 was performed. Cases were matched 1:1 by reconstruction type and age (+/-5 years) to limit procedure and age-related confounding variables. Patients with delayed mastectomy, delayed reconstruction, or bilateral cancer diagnosis at surgery were excluded. Staging, pathology, genetic, diagnostic imaging, and outcome data were collected. Complications were designated as major or minor (table), and immediate or delayed; complications <90 days postop were immediate, and >90 days postop were delayed. Therapeutic mastectomy date was used as the reference time point. Univariate statistical analyses using SAS (v. 9.4) employed Fisher’s exact test, Wilcoxon Rank Sum, and Kruskal Wallis tests.
Results: Forty-five UM cases were matched to bilateral mastectomy (BM). Mean age (n = 90) was 52.2 years (range 21.5-74.9) with mean follow up time of 7.1 years (range 0.2-19.8).There was no significant difference between UM and BM with regards to BMI, pathologic stage, follow up time, distant recurrence, or survival. For BM patients, 24/45 (53.3%) suffered 29 minor complications while 17/45 (37.7%) of UM patients suffered 24 (P=0.20). Among major complications, 11/45 (24.4%) in the BM group had 18, while 14/45 (33.3%) in the UM group had 15 (P=0.64). There was no difference between groups for delayed complications. There was a marginally significant difference in major complications for the prophylactic breast versus not: 5 BM patients (11.1%) had major complications in the prophylactic breast (P=0.056); 38.9% of major and 24.1% of minor complications were in the prophylactic breast. Of 7 major complications on the prophylactic side, 2 were delayed.
Conclusion: Our results show no significant overall differences between the two groups for complications, which may be related to low sample size and matched reconstructive approaches. However, 5 BM patients in our study had at least one major complication in their prophylactic breast, supporting the risk of adverse outcomes inherent in prophylactic surgery; patients should be adequately counseled regarding these risks in treatment planning.
