Factors Affecting Symmetrization of the Contralateral Breast: A 7-Year Unilateral Postmastectomy Breast Reconstruction Experience

Abstract

Although a number of studies compare different techniques of breast reconstruction, information documenting the factors that affect breast symmetry after unilateral mastectomy and reconstruction seems to be scarce. A statistical analysis of 606 patients undergoing unilateral mastectomy and breast reconstruction performed during a 7 year period was undertaken in an endeavor to identify these factors. Patients were classified according to time of reconstruction, method of reconstruction, type of implant, and mastectomy type. Contralateral procedures included mastopexy, augmentation, and reduction mammaplasty. Delayed reconstruction more frequently required a symmetrization than an immediate reconstruction. The percentage of contralateral procedures was higher for implant reconstructions than for autologous reconstructions, and the type of mastectomy was significantly associated with the symmetrization procedure. The findings showed that non-skin-sparing mastectomy (non-SSM) needed symmetrization surgery more frequently than did SSM procedures. The data suggest a preoperative collaboration and case study between oncologic and plastic surgeons to apply, when possible, SSM with immediate implant breast reconstruction, resulting in fewer symmetrization procedures and the best aesthetic follow-up result. These factors need to be considered when mastectomy and reconstruction are planned in order to optimize the aesthetic result together with the development of breast surgery specialty units.

Bilateral Autologous Breast Reconstruction in a Patient with Unilateral Breast Cancer: A Case Report

“…It usually provides softer tissue and more natural ptosis. It has also been associated with a more readily obtained final outcome and fewer secondary procedures [1,2,13]. Especially in small-breasted Asian women, implant-based reconstruction usually results in narrow breasts with excessive projection because small breasts tend to be wide and flat compared with most available implants [14].…”

“…Various reconstructive options are now available, including autologous tissue-based and prosthesis-based techniques. Autologous immediate reconstruction can usually provide esthetic, natural breasts with acceptable donor site morbidities in properly selected patients [2,3].…”

Breast reconstruction: current and future options

“…Patients who had delayed reconstruction were more likely to require a symmetrization when compared with those undergoing immediate reconstruction. 28 They also found the percentage of contralateral procedures was higher for patients undergoing reconstruction with implants and in patients who had a traditional versus a skin-sparing mastectomy. Skin-sparing mastectomy with immediate implant breast reconstruction resulted in fewer symmetrization procedures and the best cosmetic outcome.…”

“…Skin-sparing mastectomy with immediate implant breast reconstruction resulted in fewer symmetrization procedures and the best cosmetic outcome. 28 In addition to creating symmetry, there is also the issue of creation of a nipple for patients who undergo a traditional mastectomy. For patients undergoing reconstruction with implants, the creation of a nipple can be performed after the expander is removed and replaced with a silicone implant.…”

“…28 Procedures included mastopexy, augmentation, and reduction mastopexy. Patients who had delayed reconstruction were more likely to require a symmetrization when compared with those undergoing immediate reconstruction.…”