Contralateral prophylactic mastectomy at the time of delayed microvascular breast reconstruction adversely affects patient reported outcomes: A retrospective cohort study

Summary Purpose An increasing number of women with unilateral breast cancer are seeking bilateral mastectomies and reconstruction. At our centre many women who have undergone previous unilateral therapeutic mastectomy request contralateral prophylactic mastectomy (CPM) at the time of delayed reconstruction. These mixed timing reconstructions are particularly challenging as patients have an immediate reconstruction on one side and delayed reconstruction on the other, which may result in asymmetry. This retrospective cohort study evaluates patient reported satisfaction following mixed timing breast reconstruction and compares them to unilateral delayed reconstruction. Methods One hundred and forty-one patients who underwent successful deep inferior epigastric artery perforator (DIEP) flap breast reconstruction and completed baseline and 12-month BREAST-Qs were included in the study. Patient reported outcomes following bilateral mixed timing reconstruction (n = 56) were compared to those of unilateral delayed reconstruction without CPM (n = 85). Results Women who sought CPM were significantly younger and had lower annual incomes compared to those who underwent unilateral reconstruction. Mixed timing reconstruction was associated with significantly lower levels of breast satisfaction and psychosocial function compared to unilateral delayed reconstruction at 12 months post-operatively. 18-month BREAST-Q scores were available for 75 patients in the cohort and indicated that this decreased breast satisfaction and psychosocial impairment was sustained in the longer-term. Conclusions Patients who seek CPM at the time of delayed reconstruction should be advised that this is associated with lower levels of breast satisfaction and psychosocial well being compared to unilateral delayed breast reconstruction.