This article is more than 5 years old. Information may no longer be current.
Breast reconstruction complications higher among women who underwent bilateral mastectomy
Click Here to Manage Email Alerts
Women who underwent bilateral mastectomy experienced higher rates of complications within 30 days of autologous or implant-based reconstruction than those who underwent unilateral mastectomy, according to study results presented at the Breast Cancer Symposium.
“We think this information is really critical to guide women who are contemplating having a double mastectomy,” Mark Sisco, MD, clinical assistant professor of surgery at the University of Chicago Pritzker School of Medicine, said during a press conference. “[Although] generally very safe, double mastectomy definitely increases the rate of certain complications. While each woman will interpret these findings differently, they really should be discussed and considered.”
Sisco and colleagues used the American College of Surgeons’ National Surgery Quality Improvement Program Participant Use Files from 2005 to 2012 to identify 18,229 women who underwent mastectomy and reconstruction. About one-third of these women (n=6,502; 35.7%) underwent bilateral mastectomy.
The majority of women who opted for unilateral (79.4%) and bilateral (88.6%) mastectomy underwent implant-based reconstruction.
Researchers compared 30-day rates for complications with implant-based or autologous reconstruction in each the mastectomy cohorts.
Among women who underwent implant-based reconstruction, those who opted for bilateral mastectomy demonstrated an increased risk for implant loss (1% vs. 0.7%; adjusted OR=1.55; P=.02), transfusion (0.8% vs. 0.3%; adjusted OR=2.20; P˂.001), a hospital stay of 2 or more days (adjusted OR=2.22; P˂.001), and reoperation within 30 days (7.6% vs. 6.8%; adjusted OR=1.14; P=.05) compared with those who opted for unilateral mastectomy.
Among women who underwent autologous reconstruction, those who elected to undergo bilateral mastectomy were more likely to require transfusion (7.9% vs. 3.4%; adjusted OR=2.34; P˂.001) and a ≥2-day hospital stay (adjusted OR=2.25; P˂.001) than women who opted for unilateral mastectomy.
Rates of medical complications — such as heart attack, pneumonia and kidney failure — were comparable in both mastectomy cohorts for each type of reconstruction, and they occurred less than 1% of the time, according to researchers.
“Women choose surgery on their cancer-free breast for lots of different reasons, ranging from a desire to achieve a more symmetric look after surgery to fear of cancer coming back,” Sisco said in a press release. “Our findings show that both unilateral and bilateral procedures are safe overall, but bilateral mastectomy is associated with higher risk for certain complications. These results are reassuring for women who are considering mastectomy with reconstruction and provide additional information that may weigh in their choice of surgery.”
For more information:
Silva AK. Abstract #62. Scheduled for presentation at: Breast Cancer Symposium; Sept. 4-6, 2014; San Francisco.
Disclosure: Sisco reports a consultant/advisory role with Gerson Lehrman Group, as well as patents, royalties or other intellectual property with Pfizer.
Perspective
Back to Top
Harold J. Burstein, MD, PhD
This paper really deals with the phenomenon of more and more women choosing to have bilateral mastectomy, and the medical and surgical complications that plastic surgeons see as part of those choices. The key point here is that, on the one hand, the rate of serious complications remains quite low for either single or double mastectomy. At the same time, there is an increased risk for some rather potentially serious problems, including infection, need for implant removal and need for blood transfusion. This is really some of the first data we have seen that allow the surgical team to quantify for a woman who is deciding between single and double mastectomy what exactly the risks of the double operation might be. That is why it is so important for multidisciplinary groups to be aware of these data, and for the patients to be able to be counseled so they really understand the risks of each procedure.
Click Here to Manage Email Alerts