From the Division of Plastic and Reconstructive Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; and the Division of Plastic and Reconstructive Surgery, Northwell Health.
Plast Reconstr Surg. 2019 Jul;144(1):1-9. doi: 10.1097/PRS.0000000000005690.
The increasing trend of women with unilateral breast cancer to electively undergo contralateral prophylactic mastectomy in addition to treatment of the index breast has been controversial. The authors set out to better frame the risks and benefits of contralateral prophylactic mastectomy in the treatment of unilateral breast cancer by evaluating outcomes of a large, consecutive cohort of patients.
An institutional review board-approved review of a single-surgeon (N.T.) experience (2013 to 2018) was conducted of all consecutive patients with unilateral breast cancer treated with mastectomy and immediate reconstruction. Patient characteristics, surgical pathologic results, and 30-day complications were assessed. Outcomes of patients with unilateral cancer who underwent unilateral mastectomy versus bilateral mastectomy (with one breast being contralateral prophylactic mastectomy) were compared. Logistic regression models evaluated various risk factors for potential associations with positive pathologic findings in the contralateral prophylactic mastectomy specimen and/or postoperative complications.
Of 244 patients, 68 (27.9 percent) underwent unilateral mastectomy and 176 (72.1 percent) underwent contralateral prophylactic mastectomy. Surgical pathologic results of the prophylactic breast revealed occult ductal carcinoma in situ or invasive cancer in 13 patients (7.3 percent) and lobular carcinoma in situ in eight patients (4.6 percent). Incidence of complications was similar between groups [unilateral mastectomy, 19.12 percent (n = 13); contralateral prophylactic mastectomy, 13.07 percent (n = 23); p = 0.234].
Immediate reconstruction for unilateral mastectomy and contralateral prophylactic mastectomy have similar complication risk profiles, among patients as a whole and between individual breasts. These findings contribute to our understanding of the clinical impact prophylactic mastectomy and reconstruction may have on optimizing the counseling among extirpative surgeons, reconstructive surgeons, and patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
越来越多的单侧乳腺癌女性选择在治疗患侧乳房的同时，选择性地对另一侧乳房进行预防性乳房切除术，这一趋势一直存在争议。作者旨在通过评估一位经验丰富的外科医生（N.T.）的大量连续患者队列的结果，更好地阐述单侧乳腺癌治疗中预防性乳房切除术的风险和获益。
对 2013 年至 2018 年间接受乳房切除术和即刻重建的所有单侧乳腺癌连续患者进行了机构审查委员会批准的回顾性研究。评估了患者特征、手术病理结果和 30 天并发症。比较了接受单侧乳房切除术和双侧乳房切除术（一侧为预防性对侧乳房切除术）的单侧癌症患者的结局。逻辑回归模型评估了各种风险因素与预防性乳房切除标本中阳性病理发现和/或术后并发症的潜在相关性。
在 244 例患者中，68 例（27.9%）接受了单侧乳房切除术，176 例（72.1%）接受了预防性对侧乳房切除术。预防性乳房的手术病理结果显示 13 例（7.3%）存在隐匿性导管原位癌或浸润性癌，8 例（4.6%）存在小叶原位癌。两组的并发症发生率相似[单侧乳房切除术，19.12%（n=13）；预防性对侧乳房切除术，13.07%（n=23）；p=0.234]。
单侧乳房切除术和预防性对侧乳房切除术即刻重建的并发症风险谱在整体患者和个体乳房中相似。这些发现有助于我们理解预防性乳房切除术和重建对优化切除术外科医生、重建外科医生和患者之间的咨询可能产生的临床影响。
临床问题/证据水平：治疗性，III 级。
