Reoperations after prophylactic mastectomy with or without implant reconstruction.
BACKGROUND
The authors characterized the unanticipated reoperations after prophylactic mastectomy, with or without implant reconstruction.


METHODS
The surgical cohort was comprised of 1417 women with a family history of breast carcinoma. The women received a prophylactic mastectomy with (bilateral, n = 593; contralateral, n = 506) or without reconstruction (n = 318) at the Mayo Clinic (Rochester, MN) between 1960 and 1993. Reoperations and indications for reoperation were compiled from medical records and a patient survey.


RESULTS
Three hundred eighteen women received a bilateral (n = 39) or contralateral (n = 279) prophylactic mastectomy without reconstruction. With a median follow-up of 15 years, 18 women (6%) required reoperation. Most of these reoperations occurred within the first year after prophylactic mastectomy. Five hundred ninety-three women had reconstruction with implants following bilateral prophylactic mastectomy. Approximately one-half of the women (52%) required at least 1 unanticipated reoperation during a median follow-up of 14 years. Approximately 39% of all reoperations occurred within 1 year of breast reconstruction and 69% within 5 years. Implant-related issues were the most common cause for reoperation. Some women with breast carcinoma elected to receive contralateral prophylactic mastectomy with therapeutic mastectomy for the affected breast. Five hundred six women received reconstruction with implants. During a median follow-up of 8.8 years, 189 women (37%) required unanticipated reoperation. The most common indication was implant-related issues. The time course of reoperations was similar to that for women in the bilateral group.


CONCLUSIONS
Surgical reoperations were fairly common among women who received prophylactic mastectomy with implant reconstruction. Most of the reoperations were implant related. Reoperations were fairly uncommon after prophylactic mastectomy without reconstruction.
New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA.
Sara M
SM
Zion
Jeffrey M
JM
Slezak
Thomas A
TA
Sellers
John E
JE
Woods
Phillip G
PG
Arnold
Paul M
PM
Petty
John H
JH
Donohue
Marlene H
MH
Frost
Daniel J
DJ
Schaid
Lynn C
LC
Hartmann
D000328:Adult; D001940:Breast / Q000601:surgery*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data*; D012086:Reoperation