(S032) Complications of Contralateral Prophylactic Mastectomy With Tissue Expander Reconstruction and Potential Impact on Adjuvant Oncologic Therapy

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Article
OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

CPM with TER resulted in a complication in 25% of patients, half of which occurred within 6 months of surgery. However, adjuvant chemotherapy or radiotherapy was delayed by acute complications in only 3% after CPM. Delayed complication rates were higher on the therapeutic side, possibly due to effects of radiotherapy. These data may better inform patients considering bilateral mastectomies with TER.

Rahul D. Tendulkar, MD, Neil M. Woody, MD, Mihir Naik, DO, Chandana A. Reddy, MS, Paul Durand, MD, Adekunle Elegbede, Eliana Duraes, Stephen R. Grobmyer, MD, Joseph P. Crowe, MD, Risal Djohan, MD; Cleveland Clinic

PURPOSE: One concern of contralateral prophylactic mastectomy (CPM) is that a complication may delay adjuvant chemotherapy or radiotherapy for breast cancer. We report acute (< 6 mo), delayed (> 6 mo), and total complication rates in patients undergoing synchronous bilateral mastectomies and tissue expander reconstruction (TER), comparing complications between the ipsilateral (therapeutic) side and the contralateral (prophylactic) side within a perfectly matched cohort.

METHODS: We conducted a retrospective review of breast cancer patients treated at Cleveland Clinic from 2000–2007, and 88 women undergoing synchronous bilateral mastectomies with TER for unilateral invasive breast cancer were identified. Complications were defined as hematoma or seroma requiring reoperation, blood transfusion, capsular contracture (Baker grade III–IV), wound infection requiring intravenous (IV) antibiotics or implant removal, wound dehiscence, implant leak, and extrusion. The timing and laterality of complications were determined to compare the therapeutic and prophylactic sides.

RESULTS: The median age was 43 years (range: 23–63 yr), and the median follow-up was 6.1 years. Overall, 64 patients (73%) were premenopausal, 39 (44%) were lymph node-positive, 18 (20%) received preoperative chemotherapy, 57 (65%) received postoperative chemotherapy, and 24 (28%) received postoperative radiation therapy to the ipsilateral side. Twelve patients (14%) had received prior breast radiotherapy and underwent mastectomy for recurrence. Total complications on the therapeutic side were more common than on the prophylactic side, including wound dehiscence (4% vs 1%; P = .17), capsular contracture (13% vs 5%; P = .06), implant extrusion (10% vs 2%; P = .03), wound infection (20% vs 9%; P = .04), any complication (38% vs 25%; P = .08), and reoperation for a complication (34% vs 21%; P = .048). On the therapeutic side, 23 of 36 (64%) radiated TER patients experienced a complication compared with 10 of 52 (19%) nonirradiated patients (P < .0001). Delayed complications were more common on the therapeutic side than on the prophylactic side (24% vs 13%; P = .04), but acute complication rates were similar (14% vs 13%, respectively; P = .8). Among 11 patients with an acute complication of a CPM, receipt of postoperative chemotherapy or radiotherapy was actually delayed by a complication in 2 of 63 (3%) patients who received adjuvant treatment.

CONCLUSIONS: CPM with TER resulted in a complication in 25% of patients, half of which occurred within 6 months of surgery. However, adjuvant chemotherapy or radiotherapy was delayed by acute complications in only 3% after CPM. Delayed complication rates were higher on the therapeutic side, possibly due to effects of radiotherapy. These data may better inform patients considering bilateral mastectomies with TER.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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