Plastic Surgery Research Council
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Presenter: Eric I Chang, MD
Co-Authors: Chang EI; Selber JC; Nosrati N; Zhang TH; Robb GL; Chang DW
Fox Chase Cancer Center

Introduction: Achieving symmetry in unilateral free flap breast reconstruction often requires a contralateral procedure; however, no large studies exist that examine the timing and revisions performed on the contralateral breast. The present study examines the relationship between revision and complication rate, and the type and timing of the contralateral procedure.

Methods: Retrospective analysis was performed of all unilateral free flap breast reconstructions from January 2000-December 2010.

Results: Overall, 1120 patients underwent unilateral free flap breast reconstruction with 558 patients (49.8%) undergoing a contralateral procedure, 154 (27.6%) immediate and 404 (72.4%) delayed. Contralateral procedures included 106 augmentations, 168 reductions, 240 mastopexies, and 37 augmentation-mastopexies. Revision of the symmetry procedure was performed in 114 patients (20.8%). Augmentation and mastopexy were associated with significantly higher revision rates when performed immediately. The complication rate was higher in immediate contralateral procedures than delayed [15(9.7%) v. 16(4.0%), p = 0.01]. The average number of procedures per patient was higher in delayed contralateral procedures than immediate (2.45 v. 1.84, p < 0.0005).

Conclusions: Approximately half of patients undergoing a unilateral free flap for breast reconstruction will also undergo a contralateral balancing procedure. Immediate contralateral augmentation and mastopexy carry a higher revision rate and should be performed in a staged fashion. However, no differences in the rate of revisions were seen for breast reductions, and therefore, consideration for a simultaneous reduction is a safe and viable option. While complication rates were higher in immediate cohort, overall symmetry was achieved in significantly fewer operations.

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