Complications of Contralateral Prophylactic Mastectomy: Do
They Delay Adjuvant Therapy?
by Sharabi, Safa E.; Baumann, Donald P.; Selber, Jesse C.;
Killon, Elizabeth; Mericli, Alexander F.; Liu, Jun; Caudle, Abigail S.; Smith,
Benjamin D.; Chavez-MacGregor, Mariana; Schaverien, Mark V.
Plastic and Reconstructive Surgery: November 2020
- Volume 146 - Issue 5 - p 945-953
Background:
There is ongoing debate regarding the optimal timing of
contralateral prophylactic mastectomy fueled by concern that performing it at
the time of the mastectomy for the index breast cancer may delay adjuvant
therapy. The study objective was to examine the effect of simultaneous
contralateral prophylactic mastectomy with immediate breast reconstruction on
the complication rate and adjuvant therapy timing.
Methods:
A retrospective study was conducted of consecutive patients
who underwent contralateral prophylactic mastectomy with immediate breast
reconstruction and received adjuvant therapy over a 6-year period. Demographic,
treatment, and outcomes data were collected, and relationships between multiple
variables and outcomes were evaluated.
Results:
Of 241 patients (482 breasts) included, 186 (372 breasts)
underwent simultaneous index breast mastectomy and contralateral prophylactic
mastectomy with immediate breast reconstruction followed by adjuvant therapy
(immediate group), and 55 (110 breasts) underwent index mastectomy, then
adjuvant therapy, followed by delayed contralateral prophylactic mastectomy
with immediate breast reconstruction (delayed group). Demographics were
similar, although breast cancer stage (p < 0.001), tumor category (p = 0.0072),
and nodal category (p < 0.001) were significantly higher in the delayed
group. In the immediate group, complications before adjuvant therapy occurred
in 31 patients (16.7 percent), and in six patients (3.2 percent) complications
occurred only in the contralateral prophylactic mastectomy breast; delay to
adjuvant therapy occurred in 11 patients (5.9 percent), in four (2.2 percent)
of whom the contralateral prophylactic mastectomy breast was responsible for
the delay.
Conclusions: Contralateral prophylactic mastectomy with
immediate breast reconstruction can be performed safely at the time of the
index mastectomy in carefully selected patients. These findings will engage
patients seeking contralateral prophylactic mastectomy in shared
decision-making regarding optimal timing with respect to the risks and
benefits. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
