Annals of Surgical Oncology

, Volume 21, Issue 9, pp 2920–2927 | Cite as

Impact of Bilateral Versus Unilateral Mastectomy on Short Term Outcomes and Adjuvant Therapy, 2003–2010: A Report from the National Cancer Data Base

  • Susan M. Sharpe
  • Erik Liederbach
  • Tomasz Czechura
  • Catherine Pesce
  • David J. Winchester
  • Katharine Yao
Breast Oncology



Rates of bilateral mastectomy (BM) have increased, but the impact on length of stay (LOS), readmission rate, 30-day mortality, and time to adjuvant therapy is unknown.


Using the National Cancer Data Base, we selected 390,712 non-neoadjuvant AJCC stage 0–III breast cancer patients who underwent either unilateral mastectomy (UM) or BM from 2003 to 2010 with and without reconstruction. We used chi-square and logistic regression models for the analysis.


A total of 315,278 patients (81 %) had UM, and 75,437 (19 %) had BM; 97,031 (25 %) underwent reconstruction. The number of median days from diagnosis to UM increased from 19 days in 2003 to 28 days in 2010, and for BM, increased from 21 to 31 days (p < 0.001). BM was independently associated with a longer time to surgery when adjusting for patient, facility, and tumor factors and reconstruction (OR 1.11; 95 % CI 1.07–1.15; p < 0.001). Reconstructed patients were twice as likely to have a longer time to surgery (OR 2.07; 95 % CI 2.01–2.14; p < 0.001). The median LOS was 1 day (range 0–184 days) for UM versus 2 (range 0–182) for BM (p < 0.001); 30-day mortality and readmission rates were not different between BM and UM. The median number of days from diagnosis to definitive chemotherapy, hormonal therapy, and radiation therapy was significantly greater in the BM group.


Delays to surgical and adjuvant treatment are significantly longer for BM irrespective of reconstruction, and these delays have increased over the study period. These findings can be used by clinicians to counsel patients on BM.


Readmission Rate Contralateral Prophylactic Mastectomy Bilateral Mastectomy Facility Type National Cancer Data 
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.



We would like to thank the Auxiliary of Evanston and Glenbrook Hospitals for their generous support of this project through the Breast Research Fellowship Program.




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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Susan M. Sharpe
    • 1
  • Erik Liederbach
    • 2
  • Tomasz Czechura
    • 2
  • Catherine Pesce
    • 2
  • David J. Winchester
    • 2
  • Katharine Yao
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of Chicago, Pritzker School of MedicineChicagoUSA
  2. 2.Department of SurgeryNorthShore University Health SystemEvanstonUSA

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