Unilateral Versus Bilateral Breast Reconstruction: Is Less Really More?

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Patient Outcomes

Background:

• Increasing trend in prophylactic mastectomies and subsequent bilateral breast reconstruction.
• Need for comparative outcome data between unilateral and bilateral breast reconstruction methods.

Purpose of the Study:

• Compare patient satisfaction in unilateral versus bilateral breast reconstruction.
• Evaluate outcomes based on deep inferior epigastric perforator (DIEP) flap and tissue expander to implant (TE/I) techniques.
• Analyze satisfaction across different age and BMI groups.

Main Methods:

• Survey of 308 patients using the BREAST-Q questionnaire.
• Comparison of satisfaction scores stratified by reconstruction type (DIEP vs. TE/I) and laterality (unilateral vs. bilateral).
• Stratification by age (<55 vs. ≥55 years) and BMI (<24.9 vs. >24.9).

Main Results:

• Overall, unilateral reconstruction yielded higher satisfaction with outcome, psychosocial, and sexual well-being.
• Deep inferior epigastric perforator (DIEP) flap: Unilateral reconstruction showed greater satisfaction with outcome and sexual well-being.
• Tissue expander to implant (TE/I) reconstruction: No significant satisfaction difference between unilateral and bilateral.
• Younger patients (<55 years) were more likely to opt for bilateral reconstruction.

Conclusions:

• Unilateral DIEP flap reconstruction may enhance patient satisfaction compared to bilateral DIEP.
• TE/I reconstruction (unilateral or bilateral) results in comparable patient satisfaction.
• Younger demographics favor bilateral reconstruction, aligning with current trends.
• Unilateral DIEP flap reconstruction offers potential for improved outcomes in select patients.