Abstract 183: Contralateral Prophylactic Mastectomy And Breast Reconstruction Trends

Background: Contralateral prophylactic mastectomy (CPM) trends have changed dramatically over the past decade. Patient factors, surgeon bias and societal influences (e.g., celebrity surgical choices) all affect patient decision-making and continue to evolve. Our aim is to evaluate how these factors correlate with CPM and breast reconstruction choices. Methods: The electronic medical record was retrospectively reviewed. All mastectomies performed at our center from 2008 to 2018 were identified using a Deep6 AI® (Pasadena, CA) intelligent search engine. Only female patients with a diagnosis of breast cancer undergoing total mastectomy were included. Patients with bilateral disease and identifiable genetic risk factors were excluded. Data collected includes patient demographics, cancer treatments, tumor pathology and reconstructive choice. Statistical analyses were performed using R (GNU platform freeware). Results: 953 patients, 544 having CPM and 409 having unilateral mastectomies (UM), were included. CPM rates spiked at our institution in 2009 and 2013, each following widely publicized celebrity prophylactic mastectomies and dropping after each spike. Factors to significantly affect CPM choice included age<65 (p< 0.001), private insurance (p< 0.001), and being Caucasian (p<0.05). Post-mastectomy radiation therapy (PMRT), chemotherapy and receptor status (including triple negative) had no effects on CPM choice. CPM became progressively less likely with increasing T and N stages as well as stage IV cancer. Patients undergoing CPM were more likely to undergo reconstruction (p<0.0001) compared to UM patients, even when controlling for PMRT. UM patients who received PMRT had the lowest rates of reconstruction. Noteworthy, CPM patients were significantly less likely to undergo autologous reconstruction compared to UM patients (p<0.0001). However, radiated CPM patients were significantly more likely to undergo autologous or hybrid (latissimus/implant) reconstructions compared to non-radiated CPM patients (p=.0.0154). PMRT had no significant effect on reconstruction type in the UM patients. (p=0.232). Implant-based reconstruction was most popular in both cohorts with greater than 90% of reconstructions performed in the immediate setting. Conclusion: Tumor stage, insurance, race and age all correlate with CPM choice but there are also possible societal and cultural influences. CPM patients are significantly more likely to undergo reconstruction, most commonly immediate implant-based reconstruction. However, radiated CPM patients were significantly more likely to undergo autologous/hybrid reconstructions. Our study underscores the influence of advanced tumor stage and PMRT therapy on both cohorts. Further studies that expound why CPM patients show significant differences in reconstructive choices are needed. Understanding these trends allows reconstructive surgeons to optimize patient education and minimize health disparities.