Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy

Abstract

Background: As the rate of contralateral prophylactic mastectomy in breast cancer patients increases, more women are seeking immediate bilateral breast reconstruction. The authors evaluated complication rates in the index and prophylactic breasts in patients undergoing bilateral immediate reconstruction.

Methods: The authors retrospectively reviewed the outcomes of all consecutive patients undergoing immediate postmastectomy bilateral reconstruction for an index breast cancer combined with a contralateral prophylactic mastectomy between 2005 and 2010. Patient, tumor, reconstruction, and outcome characteristics were compared between the index and prophylactic breasts in the same patient. Patients were classified by reconstruction method: implant, abdominal flap, or latissimus dorsi flap/implant. Regression models evaluated patient and reconstruction characteristics for potential predictive or protective associations with postoperative complications.

Results: Of 497 patients included, 334 (67.2 percent) underwent implant reconstruction, 142 (28.6 percent) had abdominal flap reconstruction, and 21 (4.2 percent) had latissimus dorsi flap/implant reconstruction. Index reconstructions had a complication rate (22.5 percent) equivalent to that of contralateral prophylactic mastectomy reconstructions (19.1 percent; p=0.090). Overall, 101 patients (20.3 percent) developed a complication in one reconstructed breast, and 53 (10.7 percent) developed complications in both breasts. Of the 154 patients who developed complications, 42 (27.3 percent) developed a complication in the prophylactic breast.

Conclusions: Immediate index and contralateral prophylactic breast reconstructions appear to have equivalent outcomes, both overall and across reconstruction classifications. Together, patients, reconstructive surgeons, and extirpative surgeons should carefully consider the oncologic benefits of a contralateral prophylactic mastectomy in light of the risk of increased surgical morbidity of this type of mastectomy and reconstruction.

Clinical question/level of evidence: Therapeutic, III.