Contralateral breast symmetrisation in unilateral DIEP flap breast reconstruction

Introduction: Women undergoing unilateral DIEP flap breast reconstruction may be offered a contralateral symmetrisation either at the time of reconstruction (simultaneous/immediate) or at a later stage (delayed). Simultaneous contralateral breast symmetrisation may be more beneficial to patients and healthcare institutions by avoiding staged surgery, although there is limited evidence on which to base practice. This deficit formed the rationale for our study. The primary outcome was the overall rate of revision surgery.

Methods: Over a 6-year period, this prospective cohort study recorded the demographics, cancer treatments and operative outcomes of all consecutive unilateral DIEP flap breast reconstructions with or without contralateral symmetrising surgery. Patients were categorised into three groups: 1) simultaneous symmetrisation, 2) delayed symmetrisation, and 3) no symmetrisation for comparative analysis.

Results: During the study period, 371 women underwent unilateral DIEP flap breast reconstruction; 194 (52.3%) were not symmetrised, 155 (41.8%) were simultaneously symmetrised and 22 (5.9%) underwent delayed symmetrisation. Symmetrising the contralateral breast at the same time as unilateral DIEP flap breast reconstruction increased the mean total operative time by 28 minutes. There were no differences in the rates of peri-operative complications. There were significantly higher rates of all-cause revision surgery (OR 3.97 [1.58, 9.94], p=0.003) in women undergoing delayed symmetrisation, due to higher rates of revision lipomodelling, scar revision and revision contralateral symmetrisation.

Conclusion: Simultaneous contralateral breast symmetrisation was associated with a lower risk of all-cause revision surgery. It is safe, beneficial and likely to be more cost-effective for women undergoing unilateral free DIEP flap breast reconstruction.