The hidden costs of choice: Increased postoperative risks in patient-preference mastectomy for breast cancer.

BACKGROUND

Mastectomy rates for early-stage breast cancer have risen, yet no data currently differentiate complication risks across breast-conserving surgery (BCS), medically-necessary mastectomy (Mast-MN), and patient-preference mastectomy (Mast-PP). This study compared 30-day complications by procedure.

METHODS

Patients were prospectively enrolled. Mastectomy indication was coded preoperatively as Mast-MN when BCS was contraindicated, and Mast-PP when chosen despite BCS feasibility. 30-day complications were recorded and graded using the Clavien-Dindo system.

RESULTS

Among 929 patients (640 BCS, 202 Mast-MN, 87 Mast-PP), complication rates were 9.5%, 14.4%, and 24.1%; major complication occurred in 1.3%, 5.9%, and 13.8%, respectively. Mast-PP had higher odds of complications versus BCS (OR 2.7, 95% CI: 1.4 - 5.1). Both Mast-PP (OR 9.3, 95% CI: 3.3 - 26.0) and Mast-MN (OR 4.1, 95% CI: 1.6 - 10.9) increased odds of major complications.

CONCLUSION

Mast-PP carries higher overall and major complication risk than BCS, likely driven by reconstruction, underscoring the need for informed preoperative counseling.