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Timing of Contralateral Procedures after Unilateral Free Flap Breast Reconstruction
Eric I. Chang, M.D., Edward I. Chang, M.D., Geoffrey L. Robb, M.D., David W. Chang, M.D..
MD Anderson Cancer Center, Houston, TX, USA.

PURPOSE: Achieving symmetry in unilateral free flap breast reconstruction often requires a procedure on the contralateral breast. However, there are no large studies that examine the timing or the revisions performed on the contralateral side. Here, we examine the relationships between revisions and complication rates and between the type and timing of the contralateral procedure.
METHODS: A retrospective analysis was performed of all unilateral free flap breast reconstructions from January 2000 - December 2010 at a single academic cancer center. Patient and treatment characteristics were evaluated, including the type and timing of contralateral procedures. The effects of these factors on revision and complication rates were assessed.
RESULTS: During the study period, 1120 patients underwent unilateral free flap breast reconstruction with 558 patients (49.8%) undergoing a contralateral procedure. Of these, 154 (27.6%) were performed in the immediate setting while the remaining 404 (72.4%) were delayed. Contralateral procedures included 106 augmentations, 168 reductions, 240 mastopexies, and 37 augmentation/mastopexies. Revision of these contralateral symmetry procedures were performed in 114 patients (20.8%). Augmentations and mastopexies were associated with significantly higher revision rates when performed immediately. The complication rate was also higher in immediate contralateral procedures than delayed [15(9.7%) vs. 16(4.0%), p=0.01]. The average number of procedures per patient was higher in delayed contralateral procedures than immediate (2.45 vs. 1.84, p<0.0005).
CONCLUSIONS: Approximately half of patients undergoing a unilateral free flap for breast reconstruction will also undergo a contralateral procedure. Immediate contralateral augmentations and mastopexies carry a higher revision rate and should be performed in a staged fashion. However, no differences in the rate of revisions were seen for breast reductions; therefore, consideration for simultaneous reduction is a safe and viable option. While complication rates were higher in the immediate cohort, overall "symmetry" was achieved in significantly fewer operations.


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