Breast Cancer Surgery and Reconstruction Complications Are Rare, but Risk of Some Complications Higher With Bilateral vs Unilateral Mastectomy
A new analysis of 30-day post-surgery complications among more than 18,000 women with breast cancer undergoing bilateral and unilateral mastectomy with breast reconstruction found that complications were generally rare for either type of surgery, with an overall rate of complications of 5.3%. Bilateral mastectomy, however, was associated with higher rates of implant loss, the need for transfusion, and longer hospital stay, compared to unilateral surgery. This is the largest study to date assessing complications from unilateral vs bilateral mastectomy with reconstruction. The findings were presented at a presscast in advance of the 2014 Breast Cancer Symposium (Abstract 62).
“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. Our findings show that both unilateral and bilateral procedures are safe overall, but bilateral mastectomy is associated with higher risks for certain complications,” said lead study author Mark Sisco, MD, Clinical Assistant Professor of Surgery at the University of Chicago Pritzker School of Medicine. “These results are reassuring for women who are considering mastectomy with reconstruction and provide additional information that may weigh in their choice of surgery.”
The rate of contralateral prophylactic mastectomy has increased fivefold in the past 10 years. For the vast majority of women, there is no evidence that this procedure will improve their survival. However, for women with cancer in one breast who have a genetic predisposition for breast cancer, such as the BRCA gene mutation, or have a strong family history of breast cancer, evidence suggests that contralateral prophylactic mastectomy may improve survival.
Study Details
Researchers identified 18,229 women with breast cancer who were undergoing unilateral or bilateral mastectomy with reconstruction from the American College of Surgeons National Surgery Quality Improvement Program (NSQIP) database. Most of the patients (64.3%) underwent unilateral mastectomy, and most women in both groups received implant-based reconstruction (15,000 women in total; 88.6% of those undergoing bilateral surgery and 79.4% of those undergoing unilateral surgery), rather than autologous reconstruction. Complications arising within 30-days of surgery were assessed.
The analysis showed that among women with implant-based reconstruction, bilateral mastectomy was associated with higher rates of implant loss compared to unilateral surgery (1% vs 0.7%) and greater likelihood of needing a second operation in the first 30 days (7.6% vs 6.8%). Regardless of the type of reconstruction, bilateral mastectomy was associated with higher rates of blood transfusion due to bleeding-related complications, particularly among women who underwent autologous reconstruction (3.4% women with unilateral mastectomy surgery needed a transfusion vs 7.9% of those with bilateral mastectomy). Transfusions occurred less frequently among women who received implant-based reconstruction, with a rate of 0.3% for unilateral mastectomy and 0.8% for bilateral mastectomy.
As expected, bilateral mastectomy was associated with a longer hospital stay compared to unilateral mastectomy (1 day vs 2 days for implant-based reconstruction; 4 vs 5 days for autologous reconstruction). Overall, the rates of medical complications such as pneumonia and heart problems were low and similar between the two groups.
Risks vs Benefits of Bilateral Mastectomy
Along with other evidence, the data from this study will inform the development of much-needed decision aids to help women trying to decide between unilateral mastectomy and bilateral mastectomy.
“The era of genetic testing has raised awareness about inherited forms of breast cancer. However, for the average-risk patient with breast cancer who does not have an inherited mutation, there is often an overestimation of future risk, which may result in more extensive surgical procedures than are warranted,” said Julie Margenthaler, MD, Breast Cancer Symposium News Planning Team member. “Women also need to be informed about the increased rates of implant loss, transfusion, and reoperation that are associated with bilateral mastectomy and reconstruction vs unilateral mastectomy with reconstruction.”
This research was supported by the Section of Plastic Surgery at the University of Chicago Pritzker School of Medicine. For full disclosures of the study authors, view the study abstract at abstracts.asco.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
