Amanda K Silva1, Brittany Lapin2, Katharine A Yao3, David H Song1, Mark Sisco4. 1. Section of Plastic and Reconstructive Surgery, University of Chicago Hospitals, Chicago, IL, USA. 2. Center for Biomedical Research Informatics, NorthShore University HealthSystem Research Institute, Evanston, IL, USA. 3. Division of Surgical Oncology, NorthShore University HealthSystem, Evanston, IL, USA. 4. Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, IL, USA. msisco@northshore.org.
Abstract
BACKGROUND: Women with breast cancer are increasingly choosing to undergo contralateral prophylactic mastectomy (CPM) despite questionable survival benefit and limited data on added risks. Little is known about differences in perioperative complications between women who undergo bilateral mastectomy (BM) versus unilateral mastectomy (UM) with reconstruction. METHODS: The American College of Surgeons National Surgery Quality Improvement Program Participant Use Files (2005-2013) were used to identify women with unilateral breast cancer who underwent UM or BM with reconstruction. Adjusted 30-day complications were compared between UM and BM groups using logistic regression models. RESULTS: A total of 20,501 patients were identified, of whom 35.3 % underwent BM. Of these, 84.3 % had implant reconstruction and 15.7 % had autologous reconstruction. For all women, BM was associated with longer hospital stays (adjusted odds ratio [aOR] 1.98-2.09, p < 0.001) and a higher transfusion rate than UM (aOR 2.52-3.06, p < 0.001). BM with implant reconstruction was associated with a modestly increased reoperation rate (aOR 1.15, p = 0.029). BM with autologous reconstruction was associated with a higher wound disruption rate (aOR 2.51, p = 0.015). Surgical site infections, prosthesis failure, and medical complications occurred at similar rates in UM and BM groups. CONCLUSIONS: CPM is associated with significant increases in some, but not all, surgical site complications. CPM does not increase the likelihood of medical complications, which are generally infrequent.
BACKGROUND:Women with breast cancer are increasingly choosing to undergo contralateral prophylactic mastectomy (CPM) despite questionable survival benefit and limited data on added risks. Little is known about differences in perioperative complications between women who undergo bilateral mastectomy (BM) versus unilateral mastectomy (UM) with reconstruction. METHODS: The American College of Surgeons National Surgery Quality Improvement Program Participant Use Files (2005-2013) were used to identify women with unilateral breast cancer who underwent UM or BM with reconstruction. Adjusted 30-day complications were compared between UM and BM groups using logistic regression models. RESULTS: A total of 20,501 patients were identified, of whom 35.3 % underwent BM. Of these, 84.3 % had implant reconstruction and 15.7 % had autologous reconstruction. For all women, BM was associated with longer hospital stays (adjusted odds ratio [aOR] 1.98-2.09, p < 0.001) and a higher transfusion rate than UM (aOR 2.52-3.06, p < 0.001). BM with implant reconstruction was associated with a modestly increased reoperation rate (aOR 1.15, p = 0.029). BM with autologous reconstruction was associated with a higher wound disruption rate (aOR 2.51, p = 0.015). Surgical site infections, prosthesis failure, and medical complications occurred at similar rates in UM and BM groups. CONCLUSIONS: CPM is associated with significant increases in some, but not all, surgical site complications. CPM does not increase the likelihood of medical complications, which are generally infrequent.
Authors: Adeyiza O Momoh; Wess A Cohen; Kelley M Kidwell; Jennifer B Hamill; Ji Qi; Andrea L Pusic; Edwin G Wilkins; Evan Matros Journal: Ann Surg Date: 2017-07 Impact factor: 12.969
Authors: Jada G Hamilton; Margaux C Genoff; Melissa Salerno; Kimberly Amoroso; Sherry R Boyar; Margaret Sheehan; Megan Harlan Fleischut; Beth Siegel; Angela G Arnold; Erin E Salo-Mullen; Jennifer L Hay; Kenneth Offit; Mark E Robson Journal: Breast Cancer Res Treat Date: 2017-02-01 Impact factor: 4.872
Authors: Rachel A Greenup; Christel Rushing; Laura Fish; Brittany M Campbell; Lisa Tolnitch; Terry Hyslop; Jeffrey Peppercorn; Stephanie B Wheeler; S Yousuf Zafar; Evan R Myers; E Shelley Hwang Journal: J Oncol Pract Date: 2019-07-29 Impact factor: 3.840
Authors: Catherine Pesce; Jennifer Jaffe; Kristine Kuchta; Katharine Yao; Mark Sisco Journal: Breast Cancer Res Treat Date: 2020-10-08 Impact factor: 4.872
Authors: Anne E Mattingly; Zhenjun Ma; Paul D Smith; John V Kiluk; Nazanin Khakpour; Susan J Hoover; Christine Laronga; M Catherine Lee Journal: South Med J Date: 2017-10 Impact factor: 0.954