Breast Reconstruction in Patients with Unilateral Breast Cancer Who Choose Contralateral Prophylactic Mastectomy – An Assessment of Postoperative Morbidity
Notice bibliographique
Résumé
BACKGROUND: The benefit of contralateral prophylactic mastectomy in patients without an increased risk of contralateral disease remains a subject of debate (1-3). The potential for increased morbidity with bilateral, as opposed to unilateral, breast reconstruction in this population has not been evaluated in a prospective fashion. The aim of this study is to assess the postoperative morbidity associated with unilateral and bilateral breast reconstruction in patients with unilateral breast cancer. The hypothesis is that bilateral breast reconstructions are associated with greater complications. STUDY DESIGN: Women undergoing mastectomy and breast reconstruction for unilateral breast cancer, were recruited as part of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study. Demographic and clinical data were collected prospectively at 10 major medical centers in the United States and Canada. Postoperative complications following implant and autologous breast reconstruction in patients undergoing unilateral or bilateral mastectomy were recorded. Univariate tests and logistic regression analyses were performed to study the effects of reconstructive method, laterality, and known risk factors on surgical complication rates. RESULTS: We identified 1223 women undergoing mastectomy and reconstruction for unilateral breast cancer. Of these, 556 (45.5%) women received unilateral and 667 (54.5%) underwent bilateral mastectomies. Bilateral reconstructions were more common in women who were younger (p<0.0001), had college degrees (p=0.003), were employed (p=0.009) and had higher incomes (p=0.009). Compared with unilateral implant procedures, bilateral, implant reconstructions were associated with a higher total complication rate (26% vs 18%, p=0.006) and a higher major complication rate (17.8% vs 11.3%, p=0.009). Bilateral autologous procedures were associated with a higher risk of total complications than unilateral autologous reconstructions (56.4% vs 44.3%, p=0.031). A trend toward a higher rate of major complications after bilateral autologous reconstruction was also observed (40.6% vs 32.5%, p=0.13). Controlling for demographic and clinical covariates, bilateral autologous (OR 1.73, 95% CI 1.07-2.81) and implant reconstructions (OR 1.73, 95% CI 1.22-2.47) were associated with a higher risk of total complications compared to similar unilateral reconstructions. CONCLUSIONS: Contralateral prophylactic mastectomies with reconstruction are more often performed in younger, well-educated women, with greater financial means. Significantly higher complication rates with both implant and autologous bilateral breast reconstructions may require readmission or additional operative interventions. This information should be discussed with women at low risk for contralateral breast cancer interested in pursuing prophylactic mastectomy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».