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Annals of Surgical Oncology

, Volume 20, Issue 13, pp 4113–4120 | Cite as

Operative Risks Associated with Contralateral Prophylactic Mastectomy: A Single Institution Experience

  • Megan E. Miller
  • Tomasz Czechura
  • Brigid Martz
  • Mary E. Hall
  • Catherine Pesce
  • Nora Jaskowiak
  • David J. Winchester
  • Katharine YaoEmail author
Breast Oncology

Abstract

Background

The purpose of this study was to determine if newly diagnosed breast cancer patients undergoing contralateral prophylactic mastectomy (CPM) experience more complications than patients undergoing unilateral mastectomy (UM).

Methods

A total of 600 patients underwent either UM or CPM between January 2009 and March 2012 for unilateral breast cancer. Operative complications were classified as minor (aspirations, infection requiring antibiotics, partial flap and nipple necrosis, minor bleeding, delayed wound healing) or major (hematoma or seroma requiring operation, infection requiring rehospitalization, blood product transfusion, total flap or nipple loss, implant removal), mixed (both minor and major complications), or multiple. Chi-square and multivariate logistic regressions were used for the analysis.

Results

Of the 600 patients, 391 (65 %) underwent UM and 209 (35 %) underwent CPM. Across all complication groups, there were significantly more complications in the CPM group versus the UM group (41.6 vs. 28.6 %, p = 0.001). Major complications alone were significantly greater in the CPM versus the UM group (13.9 vs. 4.1 %, p < 0.001). When adjusting for age, body mass index, smoking and diabetes history, AJCC stage, reconstruction, previous radiation therapy, and adjuvant therapy, CPM patients were 1.5 times more likely to have any complication (odds ratio [OR] 1.53; 95 % CI 1.04–2.25, p = 0.029) and 2.7 times more likely to have a major complication compared with UM patients (OR 2.66; 95 % CI 1.37–5.19, p = 0.004).

Conclusions

CPM patients have an increased risk of complications, especially major complications requiring rehospitalization or reoperation. These complications may influence patient and physician decisions to choose CPM.

Keywords

Contralateral Prophylactic Mastectomy Operative Complication Prophylactic Mastectomy Time High Risk Bilateral Mastectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

We would like to acknowledge the Auxiliary of Evanston and Glenbrook Hospitals at NorthShore University HealthSystem who provided generous support for this work.

References

  1. 1.
    Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25:5203–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Tuttle TM, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27:1362–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998–2007. Ann Surg Oncol. 2010;17:2554–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Chung A, Huynh K, Lawrence C, Sim MS, Giuliano A. Comparison of patient characteristics and outcomes of contralateral prophylactic mastectomy and unilateral total mastectomy in breast cancer patients. Ann Surg Oncol. 2012;19:2600–6.PubMedCrossRefGoogle Scholar
  5. 5.
    King TA, Sakr R, Patil S, Gurevich I, Stempel M, Sampson M, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29:2158–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Abbott A, Rueth N, Pappas-Varco S, Kuntz K, Kerr E, Tuttle T. Perceptions of contralateral breast cancer: an overestimation of risk. Ann Surg Oncol. 2011;18:3129–36.PubMedCrossRefGoogle Scholar
  7. 7.
    Broet P, de la Rochefordiere A, Scholl SM, Fourquet A, Mosseri V, Durand JC, et al. Contralateral breast cancer: annual incidence and risk parameters. J Clin Oncol. 1995;13:1578–83.PubMedGoogle Scholar
  8. 8.
    Healey EA, Cook EF, Orav EJ, Schnitt SJ, Connolly JL, Harris JR. Contralateral breast cancer: clinical characteristics and impact on prognosis. J Clin Oncol. 1993;11:1545–52.PubMedGoogle Scholar
  9. 9.
    Peto J, Mack TM. High constant incidence in twins and other relatives of women with breast cancer. Nat Genet. 2000;26:411–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Rosen PP, Groshen S, Kinne DW, Hellman S. Contralateral breast carcinoma: an assessment of risk and prognosis in stage I (T1N0M0) and stage II (T1N1M0) patients with 20-year follow-up. Surgery. 1989;106:904–10.PubMedGoogle Scholar
  11. 11.
    Bedrosian I, Hu CY, Chang GJ. Population-based study of contralateral prophylactic mastectomy and survival outcomes of breast cancer patients. J Natl Cancer Inst. 2010;102:401–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Goldflam K, Hunt KK, Gershenwald JE, Singletary SE, Mirza N, Kuerer HM, et al. Contralateral prophylactic mastectomy. Predictors of significant histologic findings. Cancer. 2004;101:1977–86.PubMedCrossRefGoogle Scholar
  13. 13.
    Herrinton LJ, Barlow WE, Yu O, Geiger AM, Elmore JG, Barton MB, et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol. 2005;23:4275–86.PubMedCrossRefGoogle Scholar
  14. 14.
    Lee JS, Grant CS, Donohue JH, Crotty TB, Harmsen WS, Ilstrup DM. Arguments against routine contralateral mastectomy or undirected biopsy for invasive lobular breast cancer. Surgery. 1995;118:640–7; discussion 647–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Lostumbo L, Carbine N, Wallace J, Ezzo J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2004:CD002748.Google Scholar
  16. 16.
    Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZ. Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg. 2000;180:439–45.PubMedCrossRefGoogle Scholar
  17. 17.
    van Sprundel TC, Schmidt MK, Rookus MA, Brohet R, van Asperen CJ, Rutgers EJ, et al. Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers. Br J Cancer. 2005;93:287–92.PubMedCrossRefGoogle Scholar
  18. 18.
    Canavese G, Catturich A, Vecchio C, Gipponi M, Tomei D, Sertoli MR, et al. Surgical complications related to peri-operative adjuvant chemotherapy in breast cancer. Results of a prospective, controlled, randomized clinical trial. Eur J Surg Oncol. 1997; 23:10–2.PubMedCrossRefGoogle Scholar
  19. 19.
    Funnell IC, Crowe PJ, Dent DM. Does surgical experience influence mastectomy complications? Ann R Coll Surg Engl. 1992;74:178–80.PubMedGoogle Scholar
  20. 20.
    Furey PC, Macgillivray DC, Castiglione CL, Allen L. Wound complications in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction for breast cancer. J Surg Oncol. 1994;55:194–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS. Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis. 2001;33 Suppl 2:S69–77.PubMedCrossRefGoogle Scholar
  22. 22.
    Vilar-Compte D, Roldan-Marin R, Robles-Vidal C, Volkow P. Surgical site infection (SSI) rates among patients who underwent mastectomy after the introduction of SSI prevention policies. Infect Control Hosp Epidemiol. 2006;27:829–34.PubMedCrossRefGoogle Scholar
  23. 23.
    Armstrong RW, Berkowitz RL, Bolding F. Infection following breast reconstruction. Ann Plast Surg. 1989;23:284–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Contant CM, Menke-Pluijmers MB, Seynaeve C, Meijers-Heijboer EJ, Klijn JG, Verhoog LC, et al. Clinical experience of prophylactic mastectomy followed by immediate breast reconstruction in women at hereditary risk of breast cancer (HB(O)C) or a proven BRCA1 and BRCA2 germ-line mutation. Eur J Surg Oncol. 2002;28:627–32.PubMedCrossRefGoogle Scholar
  25. 25.
    Disa JJ, Ad-El DD, Cohen SM, Cordeiro PG, Hidalgo DA. The premature removal of tissue expanders in breast reconstruction. Plast Reconstr Surg. 1999;104:1662–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Lagergren J, Jurell G, Sandelin K, Rylander R, Wickman M. Technical aspects of immediate breast reconstruction with implants: five year follow-up. Scand J Plast Reconstr Surg Hand Surg. 2005;39:147–52.PubMedCrossRefGoogle Scholar
  27. 27.
    Nahabedian MY, Tsangaris T, Momen B, Manson P. Infectious complications following breast reconstruction with expanders and implants. Plast Reconstr Surg. 2003;112:467–76.PubMedCrossRefGoogle Scholar
  28. 28.
    Wickman M, Sandelin K, Arver B. Technical aspects and outcome after prophylactic mastectomy and immediate breast reconstruction in 30 consecutive high-risk patients. Plast Reconstr Surg. 2003;111:1069–77.PubMedCrossRefGoogle Scholar
  29. 29.
    Fischer JP, Sieber B, Nelson JA, Cleveland E, Kovach SJ, Wu LC, et al. Comprehensive outcome and cost analysis of free tissue transfer for breast reconstruction: an experience with 1303 flaps. Plast Reconstr Surg. 2013;131:195–203.PubMedCrossRefGoogle Scholar
  30. 30.
    Hofer SO, Damen TH, Mureau MA, Rakhorst HA, Roche NA. A critical review of perioperative complications in 175 free deep inferior epigastric perforator flap breast reconstructions. Ann Plast Surg. 2007;59:137–42.PubMedCrossRefGoogle Scholar
  31. 31.
    Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg. 2006;118:1100–9; discussion 1110–1.PubMedCrossRefGoogle Scholar
  32. 32.
    Selber JC, Kurichi JE, Vega SJ, Sonnad SS, Serletti JM. Risk factors and complications in free TRAM flap breast reconstruction. Ann Plast Surg. 2006;56:492–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Vega S, Smartt JM, Jr., Jiang S, Selber JC, Brooks CJ, Herrera HR, et al. 500 Consecutive patients with free TRAM flap breast reconstruction: a single surgeon’s experience. Plast Reconstr Surg. 2008;122:329–39.PubMedCrossRefGoogle Scholar
  34. 34.
    Montgomery LL, Tran KN, Heelan MC, Van Zee KJ, Massie MJ, Payne DK, et al. Issues of regret in women with contralateral prophylactic mastectomies. Ann Surg Oncol. 1999;6:546–52.PubMedCrossRefGoogle Scholar
  35. 35.
    Mulvihill JJ, Safyer AW, Bening JK. Prevention in familial breast cancer: counseling and prophylactic mastectomy. Prev Med. 1982;11:500–11.PubMedCrossRefGoogle Scholar
  36. 36.
    Crosby MA, Garvey PB, Selber JC, Adelman DM, Sacks JM, Villa MT, et al. Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy. Plast Reconstr Surg. 2011;128:1025–33.PubMedCrossRefGoogle Scholar
  37. 37.
    Spear SL, Schwarz KA, Venturi ML, Barbosa T, Al-Attar A. Prophylactic mastectomy and reconstruction: clinical outcomes and patient satisfaction. Plast Reconstr Surg. 2008;122:1–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Contant CM, van Geel AN, van der Holt B, Griep C, Tjong Joe Wai R, et al. Morbidity of immediate breast reconstruction (IBR) after mastectomy by a subpectorally placed silicone prosthesis: the adverse effect of radiotherapy. Eur J Surg Oncol. 2000;26:344–50.PubMedCrossRefGoogle Scholar
  39. 39.
    Cordeiro PG, Snell L, Heerdt A, McCarthy C. Immediate tissue expander/implast breast reconstruction after salvage mastectomy for cancer recurrence following lumpectomy/irradiation. Plast Reconstr Surg. 2012;129:341–50.PubMedCrossRefGoogle Scholar
  40. 40.
    Disa JJ, Cordeiro PG, Heerdt AH, Petrek JA, Borgen PJ, Hidalgo DA. Skin-sparing mastectomy and immediate autologous tissue reconstruction after whole-breast irradiation. Plast Reconstr Surg. 2003;111:118–24.PubMedCrossRefGoogle Scholar
  41. 41.
    Disa JJ, McCarthy CM, Mehrara BJ, Pusic AL, Cordeiro PG. Immediate latissimus dorsi/prosthetic breast reconstruction following salvage mastectomy after failed lumpectomy/irradiation. Plast Reconstr Surg. 2008;121:159e–64e.PubMedCrossRefGoogle Scholar
  42. 42.
    Khansa I, Colakoglu S, Curtis MS, Yueh JH, Ogunleye A, Tobias AM, et al. Postmastectomy breast reconstruction after previous lumpectomy and radiation therapy: analysis of complications and satisfaction. Ann Plast Surg. 2011;66:444–51.PubMedCrossRefGoogle Scholar
  43. 43.
    Spear SL, Ducic I, Low M, Cuoco F. The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg. 2005;115:84–95.PubMedGoogle Scholar
  44. 44.
    Craft RO, Colakoglu S, Curtis MS, Yueh JH, Lee BS, Tobias AM, et al. Patient satisfaction in unilateral and bilateral breast reconstruction [outcomes article]. Plast Reconstr Surg. 2011;127:1417–24.PubMedCrossRefGoogle Scholar
  45. 45.
    de la Pena-Salcedo JA, Soto-Miranda MA, Lopez-Salguero JF. Prophylactic mastectomy: is it worth it? Aesthetic Plast Surg. 2012;36:140–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Isern AE, Tengrup I, Loman N, Olsson H, Ringberg A et al. Aesthetic outcome, patient satisfaction, and health-related quality of life in women at high risk undergoing prophylactic mastectomy and immediate breast reconstruction. J Plast Reconstr Aesthet Surg. 2008;61:1177–87.PubMedCrossRefGoogle Scholar
  47. 47.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRefGoogle Scholar
  48. 48.
    Colakoglu S, Khansa I, Curtis MS, Yueh JH, Ogunleye A, Haewyon C, et al. Impact of complications on patient satisfaction in breast reconstruction. Plast Reconstr Surg. 2011;127:1428–36.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Megan E. Miller
    • 1
  • Tomasz Czechura
    • 2
  • Brigid Martz
    • 2
  • Mary E. Hall
    • 2
  • Catherine Pesce
    • 1
    • 2
  • Nora Jaskowiak
    • 1
  • David J. Winchester
    • 1
    • 2
  • Katharine Yao
    • 1
    • 2
    Email author
  1. 1.Department of SurgeryThe University of Chicago MedicineChicagoUSA
  2. 2.Breast Surgical Program, Department of SurgeryNorthShore University HealthSystemEvanstonUSA

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