Effect of timing on patient-reported outcomes in contralateral symmetrization surgery in autologous breast reconstruction.

backgroundThe optimal timing of contralateral symmetrization surgery (SS) in unilateral autologous breast reconstruction remains under debate. This study compared short- and long-term patient-reported outcomes between women undergoing contralateral SS during the index breast reconstruction surgery and those undergoing contralateral SS as a separate secondary surgery.

methodsA quantitative study evaluating clinical and patient-reported outcomes was conducted using prospectively collected BREAST-Q™ questionnaires and retrospectively collected patient data. All patients undergoing unilateral abdominal-based free flap breast reconstruction at Uppsala University Hospital between January 2016 and December 2023 were considered for study participation. Those who had undergone contralateral SS or were scheduled for SS on the contralateral breast at a later date and who had completed preoperative and/or postoperative patient surveys were included in the study.

resultsIn all, 91 patients were included in the study. Index breast reconstruction was performed immediately at the time of mastectomy in seven patients (7.7%) and as delayed reconstruction in 84 patients (92.3%). Forty-six patients (50.5%) underwent simultaneous contralateral SS and 45 patients (49.5%) underwent secondary contralateral SS. Among women undergoing delayed breast reconstruction, the difference in satisfaction with breasts at baseline and 3 months after the index reconstruction, was significantly higher among those undergoing simultaneous contralateral SS than among those waiting for a secondary contralateral SS (P = 0.011). Two years after the index reconstruction, when all patients were symmetrized, there was no difference in satisfaction with breasts between the two groups. There was a moderate increase in operation time at index breast reconstruction between the simultaneous and secondary contralateral SS groups (mean(s.d.) 371.8(79.1) versus 337.6(61.0) minutes, respectively; P = 0.036). There was no significant difference in the overall complication rate between the two groups (P = 0.094). As expected, the number of additional operations under general anaesthesia following the index breast reconstruction was significantly higher in the secondary contralateral SS group (P = 0.007).

conclusionSimultaneous contralateral SS may increase short-term satisfaction with breasts and lead to fewer additional surgeries requiring general anaesthesia. However, in the long term (2-year follow-up), patient satisfaction with breasts was not affected by the timing of the contralateral SS.