Mastectomía bilateral con reconstrucción inmediata como tratamiento y profilaxis del cáncer de mama: indicaciones, técnicas y complicaciones durante 15 años

Abstract

ObjectivesThe aim of this study was to analyse changes in bilateral mastectomy with immediate reconstruction (BMIR) in the treatment of unilateral cancer or as prophylaxis in high-risk patients. We also analysed variation in surgical reconstruction techniques and complications in different time periods. MethodsRetrospective analysis of patients with BMIR in the treatment and prophylaxis of breast cancer. The study periods were 2001-2006, 2007-2011 and 2012-2016. ResultsIn total, 332 BMIR interventions were performed: 110 (33.1%) in the first period, 82 (24.7%) in the second and 140 (42.2%) in the third. The most frequent indication in unilateral cancer was patient choice in the first period (12 cases [10.9%]), and multifocality and/or multicentricity in the second and third periods; 20 cases (24.4%) and 34 cases (24.3%). BMIR was performed due to histological risk in 10 (9.1%), 6 (7.3%) and 0 patients; family risk without mutation in 4 (3.6%), 3 (3.7%) and 5 patients (3.6%); and mutation in BRCA1/2 genes in 3 (2.7%), 2 (2.4%) and 14 cases (10%) in the different periods, respectively. The most commonly used techniques were Spira (39.1, 39.6, 41.4%) and external lateral incision (32.7, 25.6, 38.9%). Complication rates were similar (25%) and the main cause of reoperation due to sequels was capsular contracture in the 3 groups (17/110 [15.5%], 10/82 [12.2%] and 14/140 [10%]). ConclusionsPatients with unilateral cancer continue to request prophylactic contralateral mastectomy, while the indications for prophylactic bilateral mastectomy have varied markedly.