From the Departments of Plastic Surgery and Breast Surgical Oncology, Division of Surgery, the Department of Radiation Oncology, Division of Radiation Oncology, the Department of Breast Medical Oncology, and the Health Services Research Department, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2020 Nov;146(5):945-953. doi: 10.1097/PRS.0000000000007237.
There is ongoing debate regarding the optimal timing of contralateral prophylactic mastectomy fueled by concern that performing it at the time of the mastectomy for the index breast cancer may delay adjuvant therapy. The study objective was to examine the effect of simultaneous contralateral prophylactic mastectomy with immediate breast reconstruction on the complication rate and adjuvant therapy timing.
A retrospective study was conducted of consecutive patients who underwent contralateral prophylactic mastectomy with immediate breast reconstruction and received adjuvant therapy over a 6-year period. Demographic, treatment, and outcomes data were collected, and relationships between multiple variables and outcomes were evaluated.
Of 241 patients (482 breasts) included, 186 (372 breasts) underwent simultaneous index breast mastectomy and contralateral prophylactic mastectomy with immediate breast reconstruction followed by adjuvant therapy (immediate group), and 55 (110 breasts) underwent index mastectomy, then adjuvant therapy, followed by delayed contralateral prophylactic mastectomy with immediate breast reconstruction (delayed group). Demographics were similar, although breast cancer stage (p < 0.001), tumor category (p = 0.0072), and nodal category (p < 0.001) were significantly higher in the delayed group. In the immediate group, complications before adjuvant therapy occurred in 31 patients (16.7 percent), and in six patients (3.2 percent) complications occurred only in the contralateral prophylactic mastectomy breast; delay to adjuvant therapy occurred in 11 patients (5.9 percent), in four (2.2 percent) of whom the contralateral prophylactic mastectomy breast was responsible for the delay.
Contralateral prophylactic mastectomy with immediate breast reconstruction can be performed safely at the time of the index mastectomy in carefully selected patients. These findings will engage patients seeking contralateral prophylactic mastectomy in shared decision-making regarding optimal timing with respect to the risks and benefits.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
对于保乳手术后同期行对侧预防性乳房切除术的最佳时机仍存在争议，这主要是由于担心会延迟辅助治疗。本研究旨在探讨同期行保乳术后即刻乳房重建对并发症发生率和辅助治疗时机的影响。
对 6 年内连续接受保乳术后即刻乳房重建并接受辅助治疗的患者进行回顾性研究。收集患者的人口统计学、治疗和结局数据，并评估多个变量与结局之间的关系。
241 例（482 侧乳房）患者中，186 例（372 侧乳房）行同侧乳房切除术和同期对侧预防性乳房切除术即刻乳房重建，然后接受辅助治疗（即刻组），55 例（110 侧乳房）行同侧乳房切除术，然后接受辅助治疗，再行延迟对侧预防性乳房切除术即刻乳房重建（延迟组）。两组患者的人口统计学特征相似，但延迟组患者的乳腺癌分期（p < 0.001）、肿瘤类别（p = 0.0072）和淋巴结类别（p < 0.001）更高。即刻组有 31 例（16.7%）患者在辅助治疗前发生并发症，6 例（3.2%）仅在对侧预防性乳房切除术侧发生并发症；11 例（5.9%）患者延迟接受辅助治疗，其中 4 例（2.2%）延迟的原因为对侧预防性乳房切除术侧。
在精心挑选的患者中，同侧乳房切除术同期行对侧预防性乳房切除术即刻乳房重建是安全的。这些发现将使寻求对侧预防性乳房切除术的患者参与到有关风险和获益的最佳时机的共同决策中。
临床问题/证据水平：治疗性，III 级。
