by Sergesketter, Amanda R.; Marks, Caitlin; Broadwater,
Gloria; Shammas, Ronnie L.; Greenup, Rachel A.; Clancy, Sharon; Plichta,
Jennifer K.; Hollenbeck, Scott T.; Phillips, Brett T.
Plastic and Reconstructive Surgery: May 2022 -
Volume 149 - Issue 5 - p 1037-1047
Background:
Although breast reconstruction after bilateral mastectomies
including a contralateral prophylactic mastectomy is known to have a higher
overall complication profile, whether reconstructive complication rates differ
between the therapeutic mastectomy and contralateral prophylactic mastectomy
sides remains unclear.
Methods:
Women undergoing bilateral mastectomies with autologous or
implant-based breast reconstruction for a unilateral breast cancer at a single
institution were identified (2009 to 2019). Postoperative complications were
stratified by laterality (therapeutic mastectomy versus contralateral
prophylactic mastectomy). Paired data were analyzed to compare the risks of
complications between prophylactic and therapeutic reconstruction sides in the
same patient.
Results:
A total of 130 patients (260 reconstructions) underwent
bilateral autologous or implant-based reconstruction. Although most women
underwent a simple mastectomy, a higher proportion of therapeutic mastectomies
were modified radical mastectomies including axillary lymph node dissections
compared to contralateral prophylactic mastectomies (15.4 percent versus 0
percent). Forty-four percent of women completed postmastectomy radiation
therapy of the therapeutic side before definitive reconstruction. Overall, both
therapeutic and prophylactic reconstructions had a similar incidence of
reconstructive failure (p = 0.57), return to the operating room (p =
0.44), mastectomy skin flap necrosis (p = 0.32), seroma (p = 0.82),
fat necrosis (p = 0.16), wound infection (p = 0.56), and cellulitis (p =
0.56). Nearly one-fifth of patients experienced complications limited to the
prophylactic side [contralateral prophylactic mastectomy reconstruction
complications, n = 26 (20.0 percent); therapeutic mastectomy
reconstruction complications, n = 15 (11.5 percent)].
Conclusion:
Despite a history of local radiation therapy and more
extensive oncologic surgery on the therapeutic side, there are no significant
differences in the incidence of postsurgical complications on the therapeutic
mastectomy and contralateral prophylactic mastectomy sides after bilateral
reconstruction.
