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

• Published in: The American journal of surgery Vol. 225; no. 3; pp. 527 - 531
• Main Authors: ElSherif, Ayat, Cocco, Daniela, Bernard, Steven, Djohan, Risal, Tu, Chao, Valente, Stephanie A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023; Elsevier Limited
• Subjects: Age; Body mass index; Breast cancer; Breast Neoplasms - etiology; Cancer therapies; Chemotherapy; Complications; Contralateral prophylactic mastectomy (CPM); Decision making; Female; Humans; Implant –based reconstruction (IBR); Mammaplasty; Mastectomy; Mastectomy - adverse effects; Mastectomy, Subcutaneous; Metabolic disorders; Multivariate analysis; Nipple-sparing mastectomy; Nipples - surgery; Patients; Postoperative; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Prophylactic Mastectomy; Radiation; Radiation therapy; Regression analysis; Retrospective Studies; Simultaneous; Surgical site infections; Unilateral breast cancer; Contralateral prophylactic mastectomy (CPM); Unilateral breast cancer; Nipple-sparing mastectomy; Simultaneous; Implant –based reconstruction (IBR)
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2022.12.007

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