Abstract:
BACKGROUND:There is an increasing trend for contralateral prophylactic mastectomy, but studies focusing on bilateral free flap breast reconstruction are lacking. METHODS:A retrospective review was performed of all bilateral free flap breast reconstructions performed from 2000 to 2010. RESULTS:Overall, 488 patients underwent bilateral breast reconstruction (bilateral immediate, n = 283; bilateral delayed, n = 93; and bilateral immediate/delayed, n = 112), which more than doubled from the years 2000-2005 to 2006-2010 [147 versus 341 (232.0 percent)]. Comparison of contralateral prophylactic mastectomy demonstrated a similar increase over the decade [139 versus 282 (203.9 percent)]. There was an increasing trend toward perforator flaps [70 versus 203 (290 percent)] compared to traditional transverse rectus abdominis myocutaneous flaps [99 versus 17 (17 percent)] between the first and second halves of the decade. Patients undergoing a bilateral immediate/delayed reconstruction were significantly more likely to undergo a revision (p = 0.05), particularly on the immediate reconstructed breast (OR, 1.59; p = 0.05). Delayed reconstruction and obesity were significantly associated with postoperative complications. Obesity, smoking, and radiation therapy significantly increased fat necrosis rates, 2.77 (p = 0.01), 2.31 (p = 0.03), and 2.38 times (p = 0.03), respectively. In comparison to unilateral reconstruction, bilateral reconstruction had significantly higher flap loss rates (p = 0.004), comparable donor-site complications, and equivalent rates of revisions. CONCLUSIONS:There has been an increase in bilateral free flap breast reconstruction. Bilateral immediate/delayed reconstruction had higher revision rates of the prophylactic breast to achieve symmetry. Obesity, smoking, and radiation therapy were associated with increased complications, including fat necrosis, but successful reconstruction can be achieved with acceptable risks. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Chang EI,Chang EI,Soto-Miranda MA,Zhang H,Nosrati N,Ghali S,Chang DWdoi
10.1097/PRS.0000000000001233subject
Has Abstractpub_date
2015-06-01 00:00:00pages
946e-953eissue
6eissn
0032-1052issn
1529-4242pii
00006534-201506000-00003journal_volume
135pub_type
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