Therapeutic Vs. Prophylactic Bilateral Mastectomies: Complications And Trends In The United States
Mohammed Shaheen, JD, Arash Momeni, MD, FACS.
Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA.
PURPOSE: The "Jolie Effect" has resulted in increasing contralateral prophylactic mastectomy (CPM) rates among unilateral breast cancer (UBC) patients. Little is known, however, regarding complication rates of UBC patients undergoing CPM (BM-TP) vs. patients undergoing bilateral prophylactic mastectomy (BM-P).
METHODS: BM-TP and BM-P patients from 2015-2019 were identified in Optum Clinformatics DataMart. Six-month outcomes were assessed, including wound complications, infection, hematoma/seroma, breast pain, fat necrosis, flap failure, implant failure/removal, other flap/implant complications, and other complications. Multivariable regression models adjusted for age, residence, insurance, race, and Charlson comorbidity score. 2015-2019 CPM trends were also assessed.
RESULTS: Of 9,319 women, 7,114 (76.3%) underwent BM-TP and 2,205 (23.7%) underwent BM-P. In multivariable analysis, BM-TP had higher odds of overall complications (aOR 1.35; p=<.0001), but no difference was observed among patients who had autologous (p=0.1448) or no breast reconstruction (p=0.1530). Higher odds of overall complications persisted even after controlling for radiation therapy (aOR 1.25; p=0.0048) and chemotherapy (aOR 1.28; p=0.0047), but not after controlling for lymph node surgery (LNS) (p=0.7765). CPM rates rose significantly from 2015 to 2019, with substantial variability between age groups. Younger UBC patients consistently had higher rates of CPM.
CONCLUSION: BM-TP (vs. BM-P) patients face higher odds of overall complications without any difference in certain reconstructive modalities or after controlling for LNS. The historic trend of increasing CPM rates is continuing, particularly among younger patients.
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