Complications in patients with unilateral breast cancer who undergo contralateral prophylactic mastectomy versus unilateral mastectomy

The rate of contralateral prophylactic mastectomy has been increasing among patients with unilateral breast cancer. There remains a paucity of data regarding the impact of contralateral prophylactic mastectomy on duration of stay and complications requiring reoperation within 90 days of operation.

We reviewed the medical records of female unilateral breast cancer patients who underwent a mastectomy at a large academic institution between July 2013 and July 2016 to determine the effect of contralateral prophylactic mastectomy on complications and hospital stay.

A total of 471 patients were included in this cohort, 276 (58.6%) of whom had contralateral prophylactic mastectomy. The median patient age was 52 years (range 22-90) and median tumor size was 1.1 cm (range 0-14.6 cm). There were 52 patients (11.0%) who had complications resulting in reoperation within 90 days, including 18 instances of bleeding complications (3.8%), 9 infections (1.9%), 18 thrombosis/necrosis of flaps (3.8%), 17 skin breakdown/wound complications (3.6%), 2 seromas (0.4%), and 2 implant ruptures (0.4%). The reoperation rate did not differ between patients undergoing contralateral prophylactic mastectomy and those who opted for unilateral mastectomy (11.2% vs 10.8%, respectively; P = .99). Median duration of hospital stay for the overall cohort was 2 days. Contralateral prophylactic mastectomy was associated with a greater hospital stay than unilateral mastectomy (median 3 vs 2 days; P < .001) and was a predictor of stays ≥2 days (odds ratio = 2.369; 95% confidence interval: 1.197-4.688; P = .013) independent of reconstruction and other factors associated with contralateral prophylactic mastectomy.

Compared to unilateral mastectomy, contralateral prophylactic mastectomy was associated with an increased hospital stays but not a greater 90-day reoperation rate for complications.