Achieving Symmetry in Perforator Flap Breast Surgery
Suhail K. Kanchwala, MD, Reza Miraliakbari, MD, Joseph M. Serletti, MD.
University of Pennsylvania, Philadelphia, PA, USA.
Advances in breast reconstruction techniques in the last decade have lead to an increase in aesthetic expectations by both surgeons and patients. The modern breast reconstruction must achieve adequate size, projection, and ptosis to match the contralateral breast. Despite its importance, there remains a paucity of literature on the incidence of symmetry procedures in breast reconstruction. In addition, there are no current reports on the rates of symmetry operations performed after perforator flap breast reconstruction. The purpose of this study is to critically evaluate the number and type of symmetry procedures performed in perforator flap breast surgery.
A single surgeon retrospective review of all patients who presented for autologous breast reconstruction between 2005-2007 was performed. Study patients were identified on the basis of CPT codes for symmetry procedures (i.e. revision of reconstructed breast, contralateral mastopexy). Symmetry procedures were grouped into six categories: major revision (recreating IMC), minor revision (skin/fat excision), mastopexy, reduction, liposuction, and fat grafting. Data regarding demographic and patient variables such as risk factors and complications were recorded. Statistical analysis was performed on frequency tables using a chi squared test of significance.
250 patients (360 flaps) underwent free flap breast reconstruction during the study period. Of this group, 80 patients (110 flaps) underwent further surgery to achieve symmetry (33%). An equal number of free TRAM and DIEP/SIEA flaps were performed in this group. The average age of the study group was 51 years with a mean follow-up of 17months. Contrary to previous studies, we found that more contralateral procedures were performed overall (primarily reduction and mastopexy). There was no statistically significant difference between the free TRAM and DIEP/SIEA groups in either number or type of symmetry procedure performed. Obesity (BMI>30) resulted in a statistically significant increase in the number of symmetry procedures performed. Nevertheless, no other patient variables impacted the overall incidence of symmetry procedures. In addition, we found that post-operative radiation therapy did not increase the incidence of symmetry procedures.
The incidence of symmetry procedures in perforator flap surgery has not been previously studied. Our results demonstrate the following:
1. More symmetry procedures are performed on the contralateral breast rather than the ipsilateral breast.
2. Risk Factors (i.e. XRT, Smoking) do not increase the incidence of symmetry procedures.
3. Contralateral mastopexy/reduction can be safely performed at the time of immediate reconstruction
4. Perforator flap surgery does not impact the incidence of symmetry procedures.