Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

The Efficacy of Simultaneous Breast Reconstruction and Contralateral Balancing Procedures in Reducing the Need for Second Stage Operations

  • Smith, Mark L. (Department of Surgery, Mount Sinai Beth Israel) ;
  • Clarke-Pearson, Emily M. (Department of Surgery, Mount Sinai Beth Israel) ;
  • Vornovitsky, Michael (Department of Surgery, Mount Sinai Beth Israel) ;
  • Dayan, Joseph H. (Department of Surgery, Mount Sinai Beth Israel) ;
  • Samson, William (Department of Surgery, Mount Sinai St. Luke's-Roosevelt) ;
  • Sultan, Mark R. (Department of Surgery, Mount Sinai St. Luke's-Roosevelt)
  • Received : 2014.02.24
  • Accepted : 2014.07.27
  • Published : 2014.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Patients having unilateral breast reconstruction often require a second stage procedure on the contralateral breast to improve symmetry. In order to provide immediate symmetry and minimize the frequency and extent of secondary procedures, we began performing simultaneous contralateral balancing operations at the time of initial reconstruction. This study examines the indications, safety, and efficacy of this approach. Methods One-hundred and two consecutive breast reconstructions with simultaneous contralateral balancing procedures were identified. Data included patient age, body mass index (BMI), type of reconstruction and balancing procedure, specimen weight, transfusion requirement, complications and additional surgery under anesthesia. Unpaired t-tests were used to compare BMI, specimen weight and need for non-autologous transfusion. Results Average patient age was 48 years. The majority had autologous tissue-only reconstructions (94%) and the rest prosthesis-based reconstructions (6%). Balancing procedures included reduction mammoplasty (50%), mastopexy (49%), and augmentation mammoplasty (1%). Average BMI was 27 and average reduction specimen was 340 grams. Non-autologous blood transfusion rate was 9%. There was no relationship between BMI or reduction specimen weight and need for transfusion. We performed secondary surgery in 24% of the autologous group and 100% of the prosthesis group. Revision rate for symmetry was 13% in the autologous group and 17% in the prosthesis group. Conclusions Performing balancing at the time of breast reconstruction is safe and most effective in autologous reconstructions, where 87% did not require a second operation for symmetry.

Keywords

References

  1. Nahabedian MY. Symmetrical breast reconstruction: analysis of secondary procedures after reconstruction with implants and autologous tissue. Plast Reconstr Surg 2005;115:257-60.
  2. Nahabedian MY. Managing the opposite breast: contralateral symmetry procedures. Cancer J 2008;14:258-63. https://doi.org/10.1097/PPO.0b013e31817fbe2b
  3. Losken A, Carlson GW, Bostwick J 3rd, et al. Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience. Plast Reconstr Surg 2002;110:89-97. https://doi.org/10.1097/00006534-200207000-00016
  4. Asplund O, Svane G. Adjustment of the contralateral breast following breast reconstruction. Scand J Plast Reconstr Surg 1983;17:225-32. https://doi.org/10.3109/02844318309013122
  5. Enajat M, Smit JM, Rozen WM, et al. Aesthetic refinements and reoperative procedures following 370 consecutive DIEP and SIEA flap breast reconstructions: important considerations for patient consent. Aesthetic Plast Surg 2010; 34:306-12. https://doi.org/10.1007/s00266-009-9424-y
  6. Panettiere P, Marchetti L, Accorsi D, et al. Aesthetic breast reconstruction. Aesthetic Plast Surg 2002;26:429-35. https://doi.org/10.1007/s00266-002-2054-2
  7. Tzilinis A, Lofman AM, Tzarnas CD. Transfusion requirements for TRAM flap postmastectomy breast reconstruction. Ann Plast Surg 2003;50:623-7. https://doi.org/10.1097/01.SAP.0000054181.58934.1E
  8. Lennox PA, Clugston PA, Beasley ME, et al. Autologous blood transfusion in TRAM breast reconstruction: is it necessary? Ann Plast Surg 2004;53:532-5. https://doi.org/10.1097/01.sap.0000134342.04860.99
  9. Cohen J. Is blood transfusion necessary in reduction mammaplasty patients? Ann Plast Surg 1996;37:116-8. https://doi.org/10.1097/00000637-199607000-00018
  10. Clugston PA, Fitzpatrick DG, Kester DA, et al. Autologous blood use in reduction mammaplasty: is it justified? Plast Reconstr Surg 1995;95:824-8. https://doi.org/10.1097/00006534-199504001-00009
  11. Buenaventura S, Severinac R, Mullis W, et al. Outpatient reduction mammaplasty: a review of 338 consecutive cases. Ann Plast Surg 1996;36:162-6. https://doi.org/10.1097/00000637-199602000-00010
  12. Appleton SE, Ngan A, Kent B, et al. Risk factors influencing transfusion rates in DIEP flap breast reconstruction. Plast Reconstr Surg 2011;127:1773-82. https://doi.org/10.1097/PRS.0b013e31820cf1dd
  13. Tran NV, Evans GR, Kroll SS, et al. Postoperative adjuvant irradiation: effects on tranverse rectus abdominis muscle flap breast reconstruction. Plast Reconstr Surg 2000;106:313-7. https://doi.org/10.1097/00006534-200008000-00011
  14. Smith ML, Evans GR, Gurlek A, et al. Reduction mammaplasty: its role in breast conservation surgery for early-stage breast cancer. Ann Plast Surg 1998;41:234-9.
  15. Petit J, Rietjens M, Garusi C. Breast reconstructive techniques in cancer patients: which ones, when to apply, which immediate and long term risks? Crit Rev Oncol Hematol 2001;38:231-9. https://doi.org/10.1016/S1040-8428(00)00137-2
  16. Venus MR, Prinsloo DJ. Immediate breast reconstruction with latissimus dorsi flap and implant: audit of outcomes and patient satisfaction survey. J Plast Reconstr Aesthet Surg 2010;63:101-5. https://doi.org/10.1016/j.bjps.2008.08.064
  17. Song HM, Styblo TM, Carlson GW, et al. The use of oncoplastic reduction techniques to reconstruct partial mastectomy defects in women with ductal carcinoma in situ. Breast J 2010;16:141-6. https://doi.org/10.1111/j.1524-4741.2009.00891.x
  18. Hudson DA, Skoll PJ. Complete one-stage, immediate breast reconstruction with prosthetic material in patients with large or ptotic breasts. Plast Reconstr Surg 2002;110:487-93. https://doi.org/10.1097/00006534-200208000-00018
  19. Losken A, Pinell XA, Eskenazi B. The benefits of partial versus total breast reconstruction for women with macromastia. Plast Reconstr Surg 2010;125:1051-6.
  20. Stevenson TR, Goldstein JA. TRAM flap breast reconstruction and contralateral reduction or mastopexy. Plast Reconstr Surg 1993;92:228-33. https://doi.org/10.1097/00006534-199308000-00005
  21. Huang JJ, Wu CW, Leon Lam W, et al. Simultaneous contralateral breast reduction/mastopexy with unilateral breast reconstruction using free abdominal flaps. Ann Plast Surg 2011;67:336-42. https://doi.org/10.1097/SAP.0b013e31820859c5
  22. Inbal A, Gur E, Otremski E, et al. Simultaneous contralateral breast adjustment in unilateral deep inferior epigastric perforator breast reconstruction. J Reconstr Microsurg 2012;28:285-92. https://doi.org/10.1055/s-0032-1311682
  23. Chang EI, Selber JC, Chang EI, et al. Choosing the optimal timing for contralateral symmetry procedures after unilateral free flap breast reconstruction. Ann Plast Surg 2013 Jun 12 [Epub]. http://dx.doi.org./0.1097/SAP.0b013e31828bb1e3.
  24. Giacalone PL, Bricout N, Dantas MJ, et al. Achieving symmetry in unilateral breast reconstruction: 17 years experience with 683 patients. Aesthetic Plast Surg 2002;26:299-302. https://doi.org/10.1007/s00266-002-2034-6
  25. Gui GP, Kadayaprath G, Tan SM, et al. Evaluation of outcome after immediate breast reconstruction: prospective comparison of four methods. Plast Reconstr Surg 2005;115:1916-26. https://doi.org/10.1097/01.PRS.0000165081.54107.B9

Cited by

  1. Selection of Implants in Unilateral Prosthetic Breast Reconstruction and Contralateral Augmentation vol.44, pp.5, 2017, https://doi.org/10.5999/aps.2017.44.5.413
  2. Comparison of breast volume change between oncoplastic breast-conserving surgery with radiation therapy and a simultaneous contralateral balancing procedure through the inverted-T scar technique vol.47, pp.6, 2014, https://doi.org/10.5999/aps.2020.01123
  3. Analysis of Secondary Surgeries after Immediate Breast Reconstruction for Cancer Compared with Risk Reduction vol.8, pp.12, 2014, https://doi.org/10.1097/gox.0000000000003312