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Increased Postoperative Complications in
Bilateral Mastectomy Patients Compared
to Unilateral Mastectomy: An Analysis of
NSQIP Database
Osman F, Saleh F, Corrigan M, Jackson T, Cil T.
University of Toronto, Toronto, Canada
Introduction
• The rate of contralateral prophylactic
mastectomy among women with unilateral
breast cancer has increased
• Incidence of contralateral breast cancer is
very low
• Post-operative complications: Bilateral >
Unilateral?
Method
ACS- NSQIP Data 2007-2010
All Mastectomy Patients
N= 20,322
HighOther
Risk procedures
Pre-operative
Characteristics
Two
Sentinelcoding
Node
(Reconstruction,
Ambiguous
Axillary
dissection
etc.)
Biopsy
Code
Steroids,
Infections
and
Missing
Data
Dialysis,
Etc.
N=12,
714
N=
769
N=
1,426
N= 1194
Unilateral and Bilateral
Mastectomies with
SLNB
4,219
Unilateral Mastectomy
with SLNB
Bilateral Mastectomy
with SLNB
3, 722
497
Results: Baseline Characteristics
Unilateral
Mastectomy and
sentinel lymph node
biopsy
N (%)
Bilateral Mastectomy and
sentinel lymph node
biopsy
P-Value
N = 4,219
3,722(88.2)
497 (11.8)
N/A
Mean Age ( SD)
64.2 (13.0)
58.6 (11.8)
P<0.001
Hypertension
1,979 (50.1)
182 (39.1)
P<0.001
N (%)
ASA b
P=0.020
ASA 1
177 (4.5)
26 (5.6)
ASA 2
2,362 (59.8)
306 (65.8)
ASA 3
1,363 (34.5)
130 (28.0)
ASA 4
46 (1.2)
3 (0.7)
Diabetic
509 (12.9)
37 (8.0)
P<0.002
Mean BMI ( SD) c
28.4 (6.9)
29.2 (7.1)
P=0.024
Coronary Artery disease
185 (4.7)
15 (3.2)
P=0.193
COPD d
145 (3.7)
9 (1.9)
P=0.060
ETOH e
49 (1.2)
5 (1.1)
P=1.000
Smoker a
565 (14.3)
65 (14.0)
P<0.846
Chemotherapyf
48 (1.2)
13 (2.8)
P=0.011
Results
Complication
Unilateral
Mastectomy and
SLNB
N (%)
Bilateral Mastectomy OR (95% CI)
and SLNB
N (%)
Overall
Complications**
164 (4.2)
39 (7.6)
1.9 (1.3 –2.8)
Wound **
106 (2.9)
29 (5.8)
2.1 (1.3- 3.3)
Infectious **
29 (0.8)
11 (2.2)
2.9 (1.3- 6.0)
Respiratory
5 (0.1)
0 (0.0)
(0.0, 5.8)
Thromboembolic
10 (0.3)
1 (0.2)
0.7 (0.0, 5.3)
Renal
1 (0.03)
0 (0.0)
N/A
Neurologic
3 (0.1)
1 (0.2)
2.5 (0.04, 31.2)
Cardiac
2 (0.1)
0 (0.0)
0.0 (0.0, 14.4)
Bleeding
15 (0.4)
0 (0.0)
0.0 (0.0, 1.9)
**P-value <0.05
Multivariable Analysis of
Overall Complications
OR (95% CI)
P-Value
Bilateral vs. Unilateral
mastectomy with sentinel
lymph node biopsy
Age
1.9 (1.3- 2.8)
0.001
1.01 (1.00 - 1.02)
0.132
Diabetes
1.3 (0.9 - 1.9)
0.213
Smoker
2.2 (1.5 - 3.2)
<0.001
Body Mass Index
1.1 (1.0 - 1.1)
<0.001
Chronic obstructive pulmonary
disease
1.3 (0.7 - 2.4)
0.495
Coronary artery disease
1.4 (0.8 - 2.5)
0.246
Hypertension
1.0 (0.7 - 1.4)
0.900
ASA 3 and 4*
1.0 (0.8 - 1.5)
0.721
Chemotherapy
0.9 (0.2- 3.8)
0.877
Limitations of the Study
• Only Short-term outcomes (30-day)
• Cancer stage not reported in NSQIP data
• Procedural codes: CPM
• No Reconstruction
Conclusion
• Bilateral mastectomy appears to be associated
with an increased risk of overall post-operative
wound and other infections.
• Further studies are warranted to examine short term
and long-term complications of CPM and whether
these complications delay treatment.