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Comparison of Patient Characteristics and Outcomes of Contralateral Prophylactic Mastectomy and Unilateral Total Mastectomy in Breast Cancer Patients

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There has been an increasing trend toward contralateral prophylactic mastectomy (CPM) in the management of breast cancer (BCa). This study’s objective was to compare clinicopathologic characteristics of BCa patients who elected CPM to those who elected unilateral total mastectomy (UTM) and to determine whether CPM improved survival.

Methods

Comparison was performed on 355 patients with stage 0–III BCa matched by age and stage who underwent mastectomy from 1995 to 2008: 177 patients had CPM; 178 patients had UTM. Clinicopathological characteristics and survival outcomes were analyzed.

Results

Women who underwent preoperative MRI were twice as likely to have CPM (40.9 vs. 19.7%, P < 0.001). MRI identified additional suspicious foci in 45% CPM and 19% UTM. Patients with history of previous breast biopsies, family history, or BRCA mutation were more likely to choose CPM than UTM (40.1 vs. 24%, P = 0.001; 64.3 vs. 41.4%, P < 0.001; 20.3 vs. 6.5%, P = 0.04, respectively). CPM patients elected nipple preservation (26 vs. 5.2%, P < 0.001) and immediate reconstruction more often (92.2 vs. 73.5%, P < 0.001); UTM patients were more likely to have attempted breast conservation prior to mastectomy (52.8 vs. 39.5%, P = 0.01). CPM identified occult BCa in 11 patients (6.6%), and three UTM patients (1.7%) developed contralateral BCa. With median follow-up of 61 months, by univariable/multivariable analyses, CPM did not improve overall, disease-free, or distant metastases-free survival.

Conclusion

Factors that may influence choice of CPM included preoperative MRI, history of prior breast biopsies, immediate reconstruction, nipple preservation, family history, and BRCA status. Those who chose CPM did not have improved survival.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology at Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Alice Chung MD & Armando Giuliano MD

  2. Department of Molecular Oncology, John Wayne Cancer Institute, Santa Monica, CA, USA

    Kelly Huynh MD

  3. Department of Breast & Endocrine, John Wayne Cancer Institute, Santa Monica, CA, USA

    Camelia Lawrence MD

  4. Department of Biostatistics, John Wayne Cancer Institute, Santa Monica, CA, USA

    Myung-Shin Sim MS, PhD

Authors
  1. Alice Chung MD
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  2. Kelly Huynh MD
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  3. Camelia Lawrence MD
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  4. Myung-Shin Sim MS, PhD
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  5. Armando Giuliano MD
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Corresponding author

Correspondence to Alice Chung MD.

Additional information

Alice Chung and Kelly Huynh are co-first-authors of this manuscript.

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Chung, A., Huynh, K., Lawrence, C. et al. Comparison of Patient Characteristics and Outcomes of Contralateral Prophylactic Mastectomy and Unilateral Total Mastectomy in Breast Cancer Patients. Ann Surg Oncol 19, 2600–2606 (2012). https://doi.org/10.1245/s10434-012-2299-1

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  • DOI: https://doi.org/10.1245/s10434-012-2299-1

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