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Operative risks associated with contralateral prophylactic mastectomy: a single institution experience.

Megan E Miller1, Tomasz Czechura, Brigid Martz

  • 1Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA, megan.miller2@uchospitals.edu.

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Contralateral prophylactic mastectomy (CPM) leads to significantly more complications, including major ones, compared to unilateral mastectomy (UM) in breast cancer patients. These increased risks may affect surgical decisions for patients and physicians.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Surgery

Background:

  • Breast cancer treatment decisions involve balancing oncologic outcomes with patient quality of life.
  • Prophylactic mastectomy, either unilateral (UM) or contralateral (CPM), is a surgical option for breast cancer patients.
  • Understanding complication rates associated with UM versus CPM is crucial for informed decision-making.

Purpose of the Study:

  • To compare complication rates between patients undergoing unilateral mastectomy (UM) and contralateral prophylactic mastectomy (CPM).
  • To identify if CPM is associated with a higher risk of operative complications compared to UM.

Main Methods:

  • A retrospective study of 600 breast cancer patients who underwent UM or CPM between 2009 and 2012.
  • Complications were categorized as minor, major, mixed, or multiple.
  • Statistical analysis included chi-square tests and multivariate logistic regressions to adjust for confounding factors.

Main Results:

  • CPM was performed in 35% of patients (n=209), while UM was performed in 65% (n=391).
  • CPM patients experienced significantly higher overall complication rates (41.6% vs. 28.6%, p=0.001) and major complication rates (13.9% vs. 4.1%, p<0.001) compared to UM patients.
  • After adjusting for covariates, CPM was associated with a 1.53-fold increased risk of any complication (p=0.029) and a 2.66-fold increased risk of major complications (p=0.004).

Conclusions:

  • Contralateral prophylactic mastectomy (CPM) is associated with a significantly increased risk of operative complications, particularly major complications requiring rehospitalization or reoperation.
  • The elevated complication profile of CPM may influence the choice between CPM and unilateral mastectomy (UM) for breast cancer management.
  • These findings underscore the importance of discussing potential risks and benefits thoroughly with patients considering CPM.