title: The Effect of Contralateral Prophylactic Mastectomy on Perioperative Complications in Women Undergoing Immediate Breast Reconstruction: A NSQIP Analysis.
abstract: BACKGROUND
  Women with breast cancer are increasingly choosing to undergo contralateral prophylactic mastectomy (CPM) despite questionable survival benefit and limited data on added risks. Little is known about differences in perioperative complications between women who undergo bilateral mastectomy (BM) versus unilateral mastectomy (UM) with reconstruction.
  
  
  METHODS
  The American College of Surgeons National Surgery Quality Improvement Program Participant Use Files (2005-2013) were used to identify women with unilateral breast cancer who underwent UM or BM with reconstruction. Adjusted 30-day complications were compared between UM and BM groups using logistic regression models.
  
  
  RESULTS
  A total of 20,501 patients were identified, of whom 35.3 % underwent BM. Of these, 84.3 % had implant reconstruction and 15.7 % had autologous reconstruction. For all women, BM was associated with longer hospital stays (adjusted odds ratio [aOR] 1.98-2.09, p < 0.001) and a higher transfusion rate than UM (aOR 2.52-3.06, p < 0.001). BM with implant reconstruction was associated with a modestly increased reoperation rate (aOR 1.15, p = 0.029). BM with autologous reconstruction was associated with a higher wound disruption rate (aOR 2.51, p = 0.015). Surgical site infections, prosthesis failure, and medical complications occurred at similar rates in UM and BM groups.
  
  
  CONCLUSIONS
  CPM is associated with significant increases in some, but not all, surgical site complications. CPM does not increase the likelihood of medical complications, which are generally infrequent.
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Hospitals, Chicago, IL, USA.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Silva
authors.affiliation: Center for Biomedical Research Informatics, NorthShore University HealthSystem Research Institute, Evanston, IL, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.affiliation: Division of Surgical Oncology, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Yao
authors.affiliation: Section of Plastic and Reconstructive Surgery, University of Chicago Hospitals, Chicago, IL, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Song
authors.affiliation: Division of Plastic and Reconstructive Surgery, NorthShore University HealthSystem, Evanston, IL, USA. msisco@northshore.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Sisco
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D019928:Breast Implantation; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000517:prevention & control* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D065286:Prophylactic Surgical Procedures / Q000009:adverse effects*; D011475:Prosthesis Failure / Q000009:adverse effects; D012086:Reoperation; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology