Simultaneous contralateral prophylactic mastectomy compared to unilateral nipple-sparing mastectomy for breast cancer surgical treatment: Are complications higher?

Background: This study compared post-operative reconstructive complications and oncologic treatment between patients who underwent unilateral versus bilateral nipple sparing mastectomy (NSM) with implant based reconstruction (IBR).

Methods: Patients diagnosed with unilateral breast cancer who underwent NSM with IBR between 2010 and 2019 were reviewed. Patient demographics, surgical details, adjuvant therapy and postoperative complications were analyzed.

Results: A total of 434 NSM with IBR were performed in 269 patients, 24% unilateral, and 76% bilateral. The bilateral group received a direct implant significantly more frequently and were younger compared to unilateral (p < 0.001). The unilateral group received post-mastectomy radiation therapy at significantly higher rate (p < 0.001) with no difference in receipt of adjuvant chemotherapy. Overall, 11% of mastectomies developed a 30-day complication requiring reoperation and that extended to 13% at 120 days. There was no difference regarding the incidence of complications requiring reoperation (p = 0.84) or complications type between the two groups (p = 0.29).

Conclusion: These findings support the oncologic and reconstructive equivalence to support patient choice in CPM.