Complication Risks In Therapeutic Versus Contralateral Prophylactic Mastectomy Reconstruction In The Same Patient: A Matched Pair Analysis
Amanda R. Sergesketter, MD, Caitlin Marks, BS, Jennifer K. Plichta, MD, Sharon Clancy, MD, Brett T. Phillips, MD, MBA.
Duke University, Durham, NC, USA.
PURPOSE: While bilateral breast reconstruction after contralateral prophylactic mastectomy (CPM) has a known higher complication profile, no direct comparison has quantified complication risks between therapeutic mastectomy (TM) and CPM sides.
METHODS: Women undergoing bilateral mastectomy and reconstruction for unilateral breast cancer at a major academic center were identified. Post-operative complications were stratified by reconstruction laterality (CPM vs. TM). A 1:1 matched paired analysis was performed to compare complication risk between CPM and TM reconstructions.
RESULTS: We identified 134 patients who underwent bilateral reconstruction after TM and CPM with 42 (31.3%) autologous free flaps and 92 (68.7%) implant reconstructions. Radiation of the TM side occurred prior to reconstruction in 41.7%. While most CPMs were nipple or skin-sparing (78.4%), TMs were more often simple or modified radical (35.1%). After matched pair analysis, there was no difference in incidence of reconstructive failure, flap loss, return to the operating room, skin flap necrosis, seroma, or wound infection between CPM and TM sides (all p>0.05), though risk of hematoma (p=0.049) and nipple necrosis (p=0.03) were higher in CPM reconstructions, Table.
CONCLUSIONS: Similar complication profiles exist after reconstruction of both CPM and TM sides in the same patient, despite a history of local radiation and more extensive oncologic surgery on the TM side. Patients should be counseled that reconstruction of the non-cancerous breast bears similar rates of surgical complications and reconstructive failure. 
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