Symmetry following unilateral two-stage prosthetic breast reconstruction: Is there an optimal time for managing the contralateral breast?

Abstract

Achieving breast symmetry following unilateral mastectomy remains a challenge. Contralateral procedures are usually necessary to achieve breast symmetry. Controversy exists regarding whether these symmetry procedures should be performed at the time of the initial reconstruction or on a delayed basis. The study included 105 patients who had unilateral mastectomy, of which 55 had a simultaneous (immediate) contralateral symmetry procedure and 50 had a delayed contralateral symmetry procedure. Outcomes were compared and assessed for each cohort based on demographics, complications, and patient satisfaction. The delayed cohort required more procedures (3.4vs. 1.8, p < 0.0001) but shorter overall hospitalization length (2.8vs. 4.1 days, p < 0.0001). The two cohorts experienced a similar rate of revision (38.3% vs. 49.3%, p=0.17) The delayed cohort required a contralateral balancing procedure after completion of reconstruction more often than the immediate cohort (p=0.021). Overall reconstruction-specific complication rates were similar in both cohorts. The 36-Item Short-Form Health Survey (SF-36), a validated questionnaire for quality-of-life assessment, was administered 3 months after surgery and demonstrated that both cohorts reported similar outcomes when comparing their satisfaction with treatment. The results of this study demonstrate that immediate contralateral symmetry operations can be performed safely without increased morbidity. A new algorithm is presented.