Simultaneous contralateral reduction mammoplasty or mastopexy during unilateral free flap breast reconstruction

After unilateral breast reconstruction, a procedure on the contralateral breast is often needed to achieve symmetry. However, there is no consensus regarding when to perform the contralateral balancing procedure. Here, we present a single surgeon's experience with performing contralateral symmetry procedures simultaneously with free flap autologous breast reconstruction.

We evaluated 77 consecutive patients (mean age, 50.5 years) who underwent abdominal-based free flap unilateral breast reconstruction and a simultaneous contralateral breast procedure performed by a single surgeon.

Thirty-eight patients (49%) underwent immediate breast reconstruction, and 39 patients (51%) underwent delayed reconstruction. Forty patients (52%) received preoperative chemotherapy, and 31 (40%) received preoperative radiation therapy. Patients' mean body mass index was 28.3 kg/m. The most common free flaps were the muscle-sparing transverse rectus abdominis myocutaneous flap (n = 53) and deep inferior epigastric perforator flap (n = 22). Contralateral procedures included reduction mammoplasty (n = 48, 62%) and mastopexy (n = 29, 38%). In 43 patients (56%), breast reconstruction was completed after a single stage, and in 34 patients (44%), revisions were performed (flap: n = 16, 21%; contralateral breast: n = 8, 10%; both breasts: n = 10, 13%). Mean follow-up for patients was 53.2 months. At last follow-up, most patients had no evidence of disease (n = 68, 88%), six patients (8%) had died of disease, 1 patient (1%) was alive with disease, and 2 patients (3%) had died of other causes.

For patients who need contralateral reduction mammoplasty or mastopexy for symmetry, performing these procedures and breast reconstruction simultaneously facilitates single-stage breast reconstruction in most patients.