A NSQIP analysis of 30-day complications after bilateral versus unilateral mastectomy with immediate reconstruction.

Local/Regional Therapy
Session Type and Session Title: 
Oral Abstract Session A: Local/Regional Therapy, Survivorship, and Health Policy
General Poster Session A: Local/Regional Therapy, Survivorship, and Health Policy
Abstract Number: 
J Clin Oncol 32, 2014 (suppl 26; abstr 62)
Amanda Kathryn Silva, Brittany Lapin, Katharine Yao, David H. Song, Mark Sisco; Section of Plastic and Reconstructive Surgery University of Chicago Pritzker School of Medicine, Chicago, IL; Center for Biomedical Research Informatics, NorthShore University HealthSystem Research Institute, Evanston, IL; NorthShore University HealthSystem, Evanston, IL; Section of Plastic and Reconstructive Surgery University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Northbrook, IL

Abstract Disclosures


Background: Women with breast cancer are increasingly electing to undergo contralateral prophylactic mastectomy (CPM) despite questionable survival benefit and limited data on added risks. This study seeks to assess differences in perioperative complications between those who have bilateral mastectomy with reconstruction (BM/R) and unilateral mastectomy with reconstruction (UM/R). Methods: The American College of Surgeons National Surgery Quality Improvement Program Participant Use Files (2005-2012) were used to identify women with breast cancer undergoing UM/R or BM/R. 30-day complications after implant-based or autologous reconstruction were compared between UM/R and BM/R groups. Linear and logistic regression models were used to adjust for differences in age, obesity, smoking, diabetes, and hypertension between groups. Results: 18,229 patients were identified, of whom 6,502 (35.7%) underwent BM/R. Most patients underwent implant-based reconstruction (88.6% of BM/R and 79.4% of UM/R). Among patients with implant-based reconstruction, BM/R was associated with higher rates of implant loss (adjusted odds ratio [aOR] 1.55, p=0.02), transfusion (aOR 2.20, p<0.001), and reoperation (aOR 1.14, p=0.05) than was UM/R. Patients who had BM/R with autologous reconstruction were more likely to require transfusion (aOR 2.34, p<0.001) than those who had UM/R. BM/R was associated with a greater length of hospital stay (LOS) than was UM/R for implant and autologous reconstruction groups (aOR [for LOS ≥ 2 days] 2.22 and 2.25, respectively, p<0.001). There were no significant differences in rates of medical complications, surgical site infection, or wound disruption between UM/R and BM/R groups for either type of reconstruction. Conclusions: Women who undergo implant-based BM/R have a greater risk of implant loss and reoperation then those who undergo UM/R. Those who have BM/R are also more likely to require a transfusion and have a longer hospital stay, regardless of reconstruction type. Women considering CPM with reconstruction should be educated about these increased risks.