Is Unilateral Implant or Autologous Breast Reconstruction Better in Obtaining Breast Symmetry?

Abstract

Unilateral breast reconstruction poses a special set of challenges to the reconstructive breast surgeon compared to bilateral reconstructions. No studies to date provide an objective comparison between autologous and implant based reconstructions in matching the contralateral breast. This study compares the quantitative postoperative results between unilateral implant and autologous flap reconstructions in matching the native breast in shape, size, and projection using three-dimensional (3D) imaging. Sixty-four patients who underwent unilateral mastectomy with tissue expander (TE)-implant (n = 34) or autologous microvascular free transverse rectus abdominus myocutaneous (TRAM; n = 18) or deep inferior epigastric artery perforator (DIEP; n = 12) flap (n = 30) reconstruction from 2007 to 2010 were analyzed. Key patient demographics and risk factors were collected. Using 3D scans of patients obtained during pre and postoperative visits including over 1 year follow-ups for both groups, 3D models were constructed and analyzed for total breast volume, anterior-posterior projection from the chest wall, and 3D comparison. No significant differences in mean age, body mass index, or total number of reconstructive surgeries were observed between the two groups (TE-implant: 52.2 ± 10, 23.9 ± 3.7, 3 ± 0.9; autologous: 50.7 ± 9.4, 25.4 ± 3.9, 2.9 ± 1.3; p > 0.05). The total volume difference between the reconstructed and contralateral breasts in the TE-implant group was insignificant: 27.1 ± 22.2 cc, similar to the autologous group: 29.5 ± 24.7 cc, as was the variance of breast volume from the mean. In both groups, the reconstructed breast had a larger volume. A-P projections were similar between the contralateral and the reconstructed breasts in the TE-implant group: 72.5 ± 3.21 mm versus 71.7 ± 3.5 mm (p > 0.05). The autologous reconstructed breast had statistically insignificant but less A-P projection compared to the contralateral breast (81.9 ± 16.1 mm versus 61.5 ± 9.5 mm; p > 0.05). Variance of A-P projection from the mean was additionally insignificant between the contralateral and reconstructed breasts. Both groups produced similar asymmetry scores based on global 3D comparison (TE-implant: 2.24 ± 0.3 mm; autologous: 1.96 ± 0.2 mm; p > 0.05). Lastly, when the autologous group was further subdivided into TRAM and DIEP cohorts, no significant differences in breast volume, A-P projection or symmetry existed. Using 3D imaging, we demonstrate that both TE-implant and autologous reconstruction can achieve symmetrical surgical results with the same number of operations. This study demonstrates that breast symmetry, while an important consideration in the breast reconstruction algorithm, should not be the sole consideration in a patient' decision to proceed with autologous versus TE-implant reconstruction.

Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients

“…Many state that an autologous reconstruction should be considered the gold standard (Jagsi et al, ; Weichman et al, ). Autologous reconstructions have been found to render high level of patient satisfaction and long lasting results (Alderman et al, ; Cohen et al, ; Mehrara et al, ; Yueh et al, ). In a study by Weichman et al, only patients with BMI <22 were included and autologous microsurgical reconstructions were compared to expander/implant based reconstructions.…”

Asymétrie mammaire de l’adolescente et de la jeune adulte. Stabilité du résultat dans le temps. À propos de 144 patientes

“…La plupart des auteurs sont unanimes sur le fait que les seins évoluent indépendamment et différemment si le geste est unilatéral ou différent de chaque côté [4,5]. À la lumière des résultats de notre série et de la revue récente de la littérature, les facteurs prédictifs de l'instabilité de résultat sont représentés par l'utilisation d'une prothèse mammaire unilatérale, les variations pondérales (perte ou prise de poids excessive), les grossesses, l'allaitement, les traitements hormonaux, le vieillissement (ptôse secondaire, involution adipeuse du sein et distension cutanée) et l'anomalie malformative tubéreuse [6,7].…”

Timing between Breast Reconstruction and Oncologic Mastectomy—One Center Experience

“…Autologous reconstruction produces a more natural breast, which modifies with the variation of the body mass, being used also after radiotherapy. Implant-based reconstruction is preferred for being quicker, regarding the operating and recovery times [7]. The last method is considered to be the most performed breast reconstruction technique worldwide.…”

“…In the last 10 years, many studies assessed the satisfaction and aesthetic outcome, in order to highlight the factors for a favorable surgical outcome [7]. Yueh et al(2010), reported that autologous reconstructions are associated with higher patient satisfaction compared to prosthetic reconstruction [9], a result substantiated by Franco et al(2018), in a recent publication [10].…”