Comparing the Surgical Outcomes of Prophylactic and Therapeutic Mastectomies with Immediate Reconstruction

BACKGROUND: Although prophylactic compared to therapeutic mastectomies followed by reconstruction have been shown to result in improved aesthetics, there has been little research to date examining their comparative surgical outcomes. This study aims to examine the surgical outcomes of patients who underwent mastectomies with immediate reconstruction for breast cancer to patients who underwent the same surgery for prophylactic indications. 

METHODS: A retrospective review of females (age ≥18) who underwent mastectomy with immediate reconstruction between January 2007 and January 2017 at two tertiary care centers was conducted. Patients who underwent immediate reconstruction with autologous implants were excluded. Patients were divided into cohorts based upon whether they underwent a bilateral or unilateral procedure, and whether the procedure was therapeutic or prophylactic. Post-operative complications were compared between the cohorts.

RESULTS: A total of 318 patients who underwent mastectomy were identified. About half of the study population, 160 patients, underwent bilateral mastectomy for cancer, 29 patients (9%) underwent bilateral mastectomy for prophylaxis, 106 patients (33.3%) underwent unilateral mastectomy for cancer and 23 patients (7%) underwent unilateral mastectomy for prophylaxis. Univariate analysis of data from the bilateral mastectomy with reconstruction cohort showed patients in the therapeutic group had more comorbidities, higher BMIs, and greater ASA scores on average (All p<0.005). Postoperative outcomes were then examined by multivariate analysis, which showed no significant differences in overall complication, reoperation or readmission rates. There was however, a significantly higher surgical-site infection rate within 30-days (p<0.02) and 90-days (p<0.02) in patients who underwent a bilateral prophylactic procedure.  

CONCLUSION: Bilateral mastectomy with immediate reconstruction is a safe procedure when performed for therapeutic or prophylactic reasons. Despite being in overall better health, the prophylactic cohort had higher rates of surgical-site infections. More studies will be needed to elucidate the cause of this increased infection rate.