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Complications Uncommon After Single or Double Mastectomy

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Some women who’ve been diagnosed with early-stage breast cancer in one breast choose to have that breast and the other healthy breast removed. Removing the other healthy breast is called contralateral prophylactic mastectomy. So while a woman has cancer in just one breast, she has a double mastectomy.

The healthy breast is usually removed because of an understandable fear that a new, second breast cancer might develop in that breast. Statistics show that more and more women diagnosed with early-stage breast cancer in one breast are choosing to have the breast affected by cancer as well as the other healthy breast removed.

Because more women are opting to have both breasts removed, researchers wanted to see if women who had double mastectomy had more complications or different types of complications than women who had single mastectomy.

A study suggests that complications are uncommon after single or double mastectomy and immediate reconstruction, though women who had double mastectomy did have more complications than women who had single mastectomy. The research was presented on Sept. 4, 2014 at the 2014 ASCO Breast Conference in San Francisco. Read the abstract of “A NSQIP analysis of 30-day complications after bilateral versus unilateral mastectomy with immediate reconstruction.”

In the study, the researchers looked at information from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The NSQIP database includes information from 400 hospitals on outcomes of surgeries.

The researchers looked at the records of 11,727 women who had single mastectomy and 6,502 women who had double mastectomy from 2005 to 2012. All the women had immediate reconstruction. This means that breast reconstruction was done during the same operation right after surgery to remove one or both breasts.

About 80% of women who had single mastectomy had reconstruction using an implant and about 90% of the women who had double mastectomy had implant reconstruction.

Overall, the women had few complications.

Certain complications happened more often in women who had double mastectomy, including:

  • needing to have the implant removed or replaced
  • needing to have another operation
  • needing to have a transfusion after reconstruction with an implant
  • needing to have a transfusion after reconstruction with tissue from someplace else in the body (autologous reconstruction)

The rate of severe complications was about the same in both groups (less than 1%). Severe complications included:

  • heart attack
  • pneumonia
  • kidney failure
  • stroke
  • urinary tract infection
  • blood clots

“Complications after mastectomy with reconstruction are infrequent,” said Mark Sisco, M.D., of NorthShore University HealthSystem, at a briefing discussing the study. “Double mastectomy results in more surgical complications than single mastectomy. Women with breast cancer should consider these factors when deciding whether to undergo double mastectomy.”

Still, if you are at a higher-than-average risk of breast cancer because:

  • you know you have an abnormal gene linked to breast cancer, including BRCA1, BRCA2, or PALB2
  • you have a strong family history of breast cancer among more than one first-degree relative, such as a mother, sister, or daughter

then a double mastectomy might make sense for you.

Women who don’t have either of these factors that increase risk are very unlikely to develop a second breast cancer in the other healthy breast. (Their risk is 1% or less per year.)

Some doctors are concerned that too many women are choosing to have contralateral prophylactic mastectomy during or shortly after breast cancer surgery because they overestimate their risk of future breast cancer. Double mastectomy is a bigger operation. It’s associated with a more difficult recovery and more complications.

If you've been diagnosed with early-stage breast cancer in one breast, ask your doctor about ALL of your treatment and risk reduction options. Double mastectomy is only one of these options and is an aggressive step. While that may be the right decision for you, give yourself the time you need to consider your decision carefully. Talk to your doctor to make sure that your decisions are based on your actual risk. Ask your doctor about how the cancer details in your pathology report may affect your future risk. Together, you and your doctor can make the decisions that are best for you and your unique situation.

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