ARTICLE IN PRESS JID: YMSY [m5G;July 19, 2018;19:21] Surgery 000 (2018) 1–4 Contents lists available at ScienceDirect Surgery journal homepage: www.elsevier.com/locate/surg Complications in patients with unilateral breast cancer who undergo contralateral prophylactic mastectomy versus unilateral mastectomy Julian Huang, AB, Anees Chagpar, MD * Department of Surgery, Yale University School of Medicine, New Haven, Connecticut a r t i c l e i n f o Article history: Accepted 18 May 2018 Available online xxx a b s t r a c t Background: The rate of contralateral prophylactic mastectomy has been increasing among patients with unilateral breast cancer. There remains a paucity of data regarding the impact of contralateral prophylactic mastectomy on duration of stay and complications requiring reoperation within 90 days of operation. Methods: We reviewed the medical records of female unilateral breast cancer patients who underwent a mastectomy at a large academic institution between July 2013 and July 2016 to determine the effect of contralateral prophylactic mastectomy on complications and hospital stay. Results: A total of 471 patients were included in this cohort, 276 (58.6%) of whom had contralateral pro- phylactic mastectomy. The median patient age was 52 years (range 22–90) and median tumor size was 1.1 cm (range 0–14.6 cm). There were 52 patients (11.0%) who had complications resulting in reoperation within 90 days, including 18 instances of bleeding complications (3.8%), 9 infections (1.9%), 18 throm- bosis/necrosis of flaps (3.8%), 17 skin breakdown/wound complications (3.6%), 2 seromas (0.4%), and 2 implant ruptures (0.4%). The reoperation rate did not differ between patients undergoing contralateral prophylactic mastectomy and those who opted for unilateral mastectomy (11.2% vs 10.8%, respectively; P = .99). Median duration of hospital stay for the overall cohort was 2 days. Contralateral prophylactic mastectomy was associated with a greater hospital stay than unilateral mastectomy (median 3 vs 2 days; P < .001) and was a predictor of stays ≥2 days (odds ratio = 2.369; 95% confidence interval: 1.197–4.688; P = .013) independent of reconstruction and other factors associated with contralateral prophylactic mas- tectomy. Conclusion: Compared to unilateral mastectomy, contralateral prophylactic mastectomy was associated with an increased hospital stays but not a greater 90-day reoperation rate for complications. © 2018 Elsevier Inc. All rights reserved. Introduction The rate of contralateral prophylactic mastectomy (CPM) has more than tripled over the past 2 decades despite the lack of con- sensus that the procedure improves overall survival for breast can- cer patients. 1–10 Data from the Surveillance, Epidemiology, and End Results registry suggest that the proportion of women choosing CPM grew dramatically from 3.9% in 2002 to 12.7% in 2012. 3 Al- though a number of factors are associated with the decision to pursue CPM over unilateral mastectomy (UM) in patients with unilateral breast cancer (UBC), 11–17 the potential risk of increased complications and the impact of this on the duration of stay and reoperation must be considered. A number of studies have eval- uated the risk of complications associated with CPM, but many * Corresponding author: Yale University School of Medicine, Department of Surgery, 20 York St, Breast Center, First Floor, Suite A, New Haven, Connecticut 06510. E-mail address: anees.chagpar@yale.edu (A. Chagpar). of these studies have included more minor complications that could be managed conservatively. To understand the impact of CPM on clinically important complications, we sought to determine whether CPM was associated with a greater risk of complications requiring reoperation within 90 days of operation and the impact of this procedure on hospital stay. Methods We reviewed the medical records of all UBC patients who underwent either CPM or UM at our center between July 2013 and July 2016. Patients with bilateral breast cancer and those treated with breast-conserving operations were excluded. Clinico- pathologic and treatment data were collected, including whether patients underwent CPM or UM. In addition, we recorded the duration of hospital stay and all complications that required re- operation within 90 days of operation. Nonparametric statistical analyses were performed to determine whether CPM affected complication rate and hospital stay using SPSS version 24 (IBM https://doi.org/10.1016/j.surg.2018.05.044 0039-6060/© 2018 Elsevier Inc. All rights reserved. Please cite this article as: J. Huang, A. Chagpar, Complications in patients with unilateral breast cancer who undergo contralateral pro- phylactic mastectomy versus unilateral mastectomy, Surgery (2018), https://doi.org/10.1016/j.surg.2018.05.044