Safety of Simultaneous Contralateral Breast Symmetry Procedure in Unilateral Free Flap Breast Reconstruction

Contralateral breast symmetry procedure is often required to achieve symmetry following unilateral breast reconstruction. No consensus exists regarding timing of contralateral symmetry procedure. We investigated frequency and safety of simultaneous contralateral breast symmetry procedure in unilateral free flap breast reconstruction using a large nationwide database.

Using the American College of Surgeons National Surgery Quality Improvement Project database, we examined clinical data of patients who underwent immediate or delayed unilateral free flap breast reconstruction from 2016 to 2020 in the United States. Patients were divided in two groups: with or without simultaneous contralateral reduction mammoplasty or mastopexy.

Overall, 5.429 patients underwent unilateral free flap-based breast reconstruction. Simultaneous symmetrization was reported in only 8% of these patients. There was no significant difference in overall complication rate (without: 15.9% vs. with: 15.2%), unplanned return to the operating room rate (without: 10.9% vs. with: 8.3%), mean length of hospital stay (without: 3.8 vs. with: 3.5 day) and unplanned re-admission rate (without: 5.5% vs. with: 4.1%) between two groups. Additionally, multivariate regression analyses showed simultaneous symmetrization was not associated with higher complication rate, higher unplanned return to the operating room rate, higher readmission rate, nor longer length of hospital stay after adjusting for patient's characteristics, comorbidities and immediate versus delayed breast reconstruction.

Simultaneous symmetrization was performed infrequently with unilateral free flap breast reconstruction. Our study showed simultaneous symmetrization is safe and associated with a comparable perioperative outcome. Consideration in appropriate patients will likely reduce the number of revisions for those undergoing unilateral free flap breast reconstruction.