From the Division of Plastic Surgery, Columbia University Irving Medical Center.
Columbia University Medical School, New York, NY.
Ann Plast Surg. 2021 Jul 1;87(1s Suppl 1):S2-S6. doi: 10.1097/SAP.0000000000002802.
An increasing number of women are choosing to undergo contralateral prophylactic mastectomy with immediate bilateral breast reconstruction. Operating on the contralateral noncancer side is not without its own set of risks. We sought to compare complication rates between the cancerous and contralateral prophylactic breasts.
A retrospective review was conducted of all patients undergoing immediate postmastectomy bilateral breast reconstruction for unilateral breast cancer between January 2008 and January 2019 at a single institution. Data were collected on patient demographics, cancer and adjuvant/neoadjuvant treatments, tumor, reconstruction, hospital stay, and complications. Complications were compared between the cancerous and the noncancerous breasts.
One hundred sixty patients met the inclusion criteria of this study. Of these 160 patients, 33 (20.6%) had complications (major and minor) only to the cancerous breast, 7 (4.4%) had complications only to the noncancerous breast, and 7 (4.4%) had bilateral complications. Most patients underwent tissue expander/implant reconstruction (93.8%) with the rest (6.2%) undergoing abdominally based flap or latissimus dorsi flap reconstruction. Patients with complications were more likely to have hypertension, diabetes, exposure to radiation, and neoadjuvant chemotherapy. Complications included wound dehiscence, hematoma, cellulitis, seroma, capsular contracture, infected implant, and skin necrosis. Overall, there were significantly more complications to the cancerous breasts than the noncancerous breasts (P < 0.001). In addition, although exposure to radiation to the affected side significantly increased the likelihood of complications to that side (P < 0.0001), patients who were not exposed to any radiation were also more likely to have complications to the cancer side than to the noncancer side (P = 0.00065). However, after controlling for the effects of radiation, there was no significant difference in complications between the cancer side and the prophylactic side when stratifying by specific complications.
Although contralateral prophylactic mastectomy with immediate bilateral reconstruction is not without added risk when compared with a unilateral procedure, this study shows that the incidence of complications to the noncancerous breast is less than that to the cancerous breast. This information can be used to help counsel patients with unilateral breast cancer on their treatment options and associated risks.
越来越多的女性选择接受对侧预防性乳房切除术并立即进行双侧乳房重建。对非癌侧进行手术并非没有其自身的一系列风险。我们旨在比较癌症侧和对侧预防性乳房的并发症发生率。
对 2008 年 1 月至 2019 年 1 月期间在一家机构接受单侧乳腺癌即刻乳房切除术后双侧乳房重建的所有患者进行回顾性分析。收集患者人口统计学资料、癌症及辅助/新辅助治疗、肿瘤、重建、住院时间和并发症等数据。比较癌症侧和非癌症侧的并发症。
160 例患者符合本研究纳入标准。在这 160 例患者中，仅癌症侧出现（主要和次要）并发症的有 33 例（20.6%），仅非癌症侧出现并发症的有 7 例（4.4%），双侧出现并发症的有 7 例（4.4%）。大多数患者接受了组织扩张器/植入物重建（93.8%），其余 6.2%接受了腹部皮瓣或背阔肌皮瓣重建。有并发症的患者更有可能患有高血压、糖尿病、接受过放疗和新辅助化疗。并发症包括伤口裂开、血肿、蜂窝织炎、血清肿、包膜挛缩、感染的植入物和皮肤坏死。总体而言，癌症侧的并发症明显多于非癌症侧（P<0.001）。此外，尽管患侧接受放疗显著增加了该侧发生并发症的可能性（P<0.0001），但未接受任何放疗的患者癌症侧发生并发症的可能性也高于非癌症侧（P=0.00065）。然而，在控制放疗影响后，按特定并发症分层时，癌症侧和预防性侧的并发症发生率没有显著差异。
虽然与单侧手术相比，对侧预防性乳房切除术联合即刻双侧重建并非没有额外风险，但本研究表明，非癌症侧的并发症发生率低于癌症侧。这些信息可用于帮助单侧乳腺癌患者了解其治疗方案和相关风险。
