Immediate versus Delayed Contralateral Breast Symmetrisation in Breast Reconstruction with Latissimus dorsi Flap: A Comparative Study

Abstract

To achieve symmetry in unilateral free flap breast reconstruction often requires a contralateral procedure. There is no evidence in the literature to support the benefit of immediate contralateral breast symmetrisation concomitant to breast reconstruction. We hypothesized that performing a simultaneous contralateral balancing operation at the time as the initial reconstruction might provide immediate symmetry and minimize the frequency of secondary procedures. Thus, we performed a comparative study on this issue. A comparative retrospective study was conducted on 78 consecutive patients who underwent unilateral breast reconstruction surgery with latissimus dorsi (LD) flap and contralateral breast symmetrisation from January 2014 to June 2016 at Turku University Hospital. Exclusion criteria included other breast reconstruction techniques and no contralateral symmetrisation at follow-up. The patients were divided according to the timing of contralateral breast balancing operation into an immediate versus a delayed group. Postoperative complications, outcomes, and re-operations were compared. Baseline characteristics were well balanced between the groups except for comorbidity, which was significantly higher in the immediate group. Mastectomy weights (735.6 vs. 390.7 g, p = 0.015), contralateral breast reduction weights (268.3 vs. 105.8 g, p = 0.014), and implant size (218.9 vs. 138.9 g, p = 0.001) were significantly larger in the immediate group. No significant differences in any kind of complications were detected. Similarly, the rates of re-operations were similar among the groups (24.0 vs. 43.3%, p = 0.134). Performing immediate symmetrisation at the time of breast reconstruction is safe and feasible in autologous LD breast reconstructions, where 76% did not require a second operation for symmetry. There were no differences in the rate of any re-operation and, therefore, performance of simultaneous contralateral reduction is a reasonable option.

Immediate Symmetrization of the Contralateral Breast in Breast Reconstruction–Revision, Complications, and Satisfaction: A Systematic Review

“…Nevertheless, some studies showed no differences in complication rates between the two groups, and no study reported that complication rates were higher in the immediate group. [23][24][25] Regarding satisfaction, most studies showed that immediate symmetrization had higher scores, regardless of statistical significance, but the breast satisfaction score was significantly higher in the immediate group than in the delayed group (P < 0.05). 2 Additionally, psychosocial well-being was higher in the immediate group.…”

“…The first study showed no significant differences in complication rates, the second reported no major complication, and the third reported no complications in immediate symmetrization and two complications (0.93%) for delayed symmetrization. [23][24][25] Three studies did not mention the specific complications, and two did not mention the complication rate. [20][21][22]26,27 Four of five studies included immediate cases alone without comparisons with delayed symmetrization.…”

Controlateral Symmetrisation in SRM for Breast Cancer: Now or Then? Immediate versus Delayed Symmetrisation in a Two-Stage Breast Reconstruction

“…Giordano et al [ 10 ] demonstrated that performing immediate symmetrisation at the time of a breast reconstruction was a reasonable and safe option in autologous latissimus dorsii breast reconstructions.…”

“…Although the results were reassuring, patients with macromastia and ptotic breasts remained a stimulating group to treat; the timing of contralateral symmetrisation remains one of the most debated topics in the breast reconstruction field [ 8 , 9 , 10 ].…”

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

“…This can be followed at a later stage with tattooing to recreate the areolar complex [ 49 ]. Patients are also offered a modification of the contralateral breast if they are unhappy with the degree of asymmetry [ 50 ], [ 51 ]. This involves a mastopexy, reduction or augmentation with a breast implant for completion [ 50 ], [ 51 ].…”