Mastectomy Plus Reconstruction Has Highest Complication Rate

Benjamin D. Smith, MD

Among guideline-suggested local treatment options for women with early-stage breast cancer, the combination of mastectomy and reconstruction has the highest rate of complications and is highest in cost, according to the results of a new study. The risk of complications from a mastectomy plus reconstruction for both younger and older women was two times higher compared with the risks of lumpectomy plus whole-breast irradiation (WBI).

These results (abstract S3-07) were presented at the 2015 San Antonio Breast Cancer Symposium, held December 8–12 in San Antonio, Texas.

“When patients receive local therapy that’s concordant with guidelines, our feeling is that their survival is excellent and essentially equivalent regardless of the local therapy chosen,” said study author and presenter Benjamin D. Smith, MD, associate professor and research director of the breast radiation oncology section in the department of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston, at a press conference. “However, these local therapies differ significantly in the extent of surgery and radiation that is delivered.”

To compare the value of different local breast cancer treatment options, Smith and colleagues collected and analyzed the health records of more than 100,000 women diagnosed between 2000 and 2011.

For breast cancer patients younger than age 65, the risk of complications was 56% with the mastectomy plus reconstruction combination compared with 45% for lumpectomy plus brachytherapy, 30% for lumpectomy plus WBI, and 25% for mastectomy alone.

For patients older than age 65, the risks were 69% for mastectomy plus reconstruction, 51% for lumpectomy plus brachytherapy, 38% for lumpectomy plus WBI, 37% for mastectomy alone, and 31% for lumpectomy alone.

For younger women, the cost of mastectomy plus reconstruction was $89,140, the most expensive treatment option-$23,421 more expensive than a lumpectomy plus WBI.

The most costly treatment combinations for older Medicare patients were mastectomy plus reconstruction and lumpectomy plus brachytherapy, priced at $36,166 and $37,741, respectively. Lumpectomy plus WBI cost Medicare patients $34,097.

Complication-related costs for mastectomy plus reconstruction were $8,608 higher than those for a lumpectomy plus WBI for privately insured younger women and $2,568 higher for those on Medicare. Common complications included infections, some of which required hospitalizations or procedures; seroma or hematoma; and graft or implant complications.

Mastectomies have been on the rise since 2005, with nearly 40% of early breast cancer patients receiving a mastectomy along with breast reconstructive surgery.

“Mastectomy plus reconstruction is not terribly more expensive if you can avoid complications in older Medicare patients,” said Smith. He noted that mastectomies are generally safe and cost-effective. “It is in adding reconstruction that complications can occur.”

One caveat to note when interpreting the findings, said Smith, is that the results are most relevant when contemplating the initial management strategies of lumpectomy or mastectomy. “If a mastectomy has been performed, reconstruction is generally considered a high-value intervention and it would be inappropriate to conclude otherwise.”