Achieving symmetry in unilateral breast reconstruction: 17 years experience with 683 patients

Breast symmetry is one of the most important parameters of patient satisfaction in breast reconstruction. We undertook this retrospective study to determine whether autologous reconstruction requires opposite-breast procedures less often to achieve symmetry than do non-autologous techniques. The records of 683 patients who underwent delayed breast reconstruction between March 1983 and March 2000 were reviewed. Two hundred and twelve patients (31%) received a TRAM flap, 167 (24%) received a latissimus dorsi myocutaneous flap plus implant (LD), and 304 patients (45%) underwent saline-filled implant (I) reconstruction. The type of opposite surgery was analyzed and compared among groups. An inverted-T breast reduction or mastopexy was performed with equal frequency in the three groups (respectively, 33.5%, 37.8%, and 27.6%). Mastopexy using a circumareolar technique was less frequently performed in the TRAM group (1.9%) than in the other two groups (5.3% and 8.2%, respectively; p = 0.012). Breast augmentation was essentially performed in the LD (30.5%) and I (21.7%) groups, and the difference was statistically significant (p = 0.03). Only one patient of the TRAM group underwent augmentation mammaplasty. The total prevalence of opposite breast procedures was different between the TRAM group (35.5%) and the other two groups (67% in the LD group and 54.6% in the I group; p = 0.001). Our study clearly demonstrates that TRAM flap breast reconstruction more frequently matches the opposite breast, thus avoiding additional surgery to achieve symmetry, in comparison with implant-based techniques.