Morbidity and Quality of Life Outcomes of Breast Reconstruction for Unilateral Mastectomy vs. Additional Contralateral Prophylactic Mastectomy: a Cohort Study of 211 Breast Reconstruction PatientsMorbidity and Quality of Life Outcomes of Breast Reconstruction for Unilateral Mastectomy vs. Additional Contralateral Prophylactic Mastectomy: a Cohort Study of 211 Breast Reconstruction Patients
Mohamad E. Sebai, MBBS, Ricardo J. Bello, MD, MPH, Eric L. Wan, BS, Charalampos Siotos, MD, Jeff Aston, BS, David Cui, NA, Julie Lee, NA, Sethly Davis, NA, Justin M. Sacks, Sacks, Michele A. Manahan, MD, Carisa M. Cooney, MPH, Gedge D. Rosson, MD, Mehran Habibi, MD, MBA.
The Johns Hopkins Hosptial, Baltimore, MD, USA.
Purpose: Contralateral prophylactic mastectomy at the time of therapeutic mastectomy for unilateral breast cancer rates have more than tripled in the past decade despite the lack of evidence for survival benefit. We investigated morbidity and patient-reported quality of life (QoL) outcomes of performing a contralateral prophylactic mastectomy followed by bilateral breast reconstruction (CBR) compared to unilateral mastectomy and breast reconstruction (UR). Methods: Using IRB-approved, prospectively collected breast reconstruction registry, we queried pre- and post-operative data from patients who underwent CBR or UR at our institution. We used simple and multiple linear regression to compare morbidity and QoL changes between study groups (CBR vs. UR). Results: Between 2010 and 2015, 211 patients underwent CBR (n=86, 40.8%) or UR (n=125, 59.2%). While the unadjusted surgical morbidity was significantly higher for the BR group at 60 days post-tissue expander placement (p<0.001), it was not significantly different between groups immediately before final reconstruction, at 60 days post-final reconstruction, orat 1 year post-final reconstruction. After adjusting for possible cofounders, CBR patients did not have a statistically significant difference in pre- to post-reconstruction changes of QoL when compared to UR in the domains of Satisfaction with Breast (p=0.62), Psychosocial Well-being (p=0.71), Sexual Well-being (p=0.85), and Chest Physical Well Being (p=0.09). Conclusions: Our findings suggest that performing a CBR for unilateral breast cancer is not associated with higher QoL compared to UR. There was a higher rate of short-term complications for staged breast reconstruction following tissue expander placement for the CBR group but not at long-term.
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