Breast reconstruction in patients with personal and family history of breast cancer undergoing contralateral prophylactic mastectomy, a 10-year experience

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Abstract
Background. The purpose of this study was to evaluate the clinical course of breast reconstruction in patients with personal and family history of breast cancer undergoing contralateral prophylactic mastectomy (CPM) and elucidate the association between reoperation risk and adjuvant treatment. Methods. A descriptive retrospective study of a consecutive series of breast cancer patients who underwent CPM with breast reconstruction at Karolinska University Hospital between 1998 and 2008 was performed. Reoperation was chosen as an outcome variable assessing morbidity and thus documented for each patient and for each reconstructed breast. Regression analyses were performed to evaluate the risk of reoperation after bilateral breast reconstruction. Results. Ninety-one patients underwent CPM during the study period. Their mean age at CPM was 45.3 years (SD =9.4). No contralateral breast cancer was diagnosed after CPM during the median follow-up period of 3.9 years. All women, but two, received an implant based breast reconstruction. The majority (n =75, 82%) underwent CPM with concurrent bilateral breast reconstruction. Overall, after bilateral breast reconstruction 45/75 (60%) required at least one reoperation on the CPM side (n =2, 3%), therapeutic mastectomy (TM) side (n =17, 23%) or both sides (n =26, 33%). In the paired analyses, the probability of reoperation was significantly higher after TM reconstruction as compared to CPM (0.57 vs. 0.37, p =0.001). The mean number of reoperations required for completion of TM and CPM reconstruction was 0.84 and 0.49, respectively (p =0.003). Among all potential risk factors, only radiotherapy was associated with reoperation after bilateral breast reconstruction (odds ratio [OR]: 4.2, 95% CI, 1.3 to 13.6, p =0.015). Conclusions. Breast reconstruction in patients with personal and family history of breast cancer is a complex operation. This study found that the clinical course after bilateral breast reconstruction was predominantly affected by reoperations on the TM side and given radiotherapy was associated with reoperation. Further studies are necessary to examine the possible predictors of unanticipated reoperations in candidates for CPM with breast reconstruction.

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