BACKGROUND: Women undergoing breast reconstruction often benefit from procedures performed on the contralateral breast to improve symmetry. However, the ideal time at which the balancing procedure should be performed remains controversial. Some surgeons believe that simultaneous breast reduction, especially larger reductions, may increase the risk of transfusion. This study evaluates breast reconstructions performed with simultaneous balancing procedures on the contralateral breast to see if this approach was practical. In addition, we examined the relationship between body mass index (BMI), mammaplasty specimen weight and need for blood transfusion.
METHODS:All patients who underwent breast reconstruction after mastectomy between 1999 and 2006 were reviewed. There were 103 breast reconstructions performed in conjunction with a contralateral balancing procedure. Data obtained included patient age, type of reconstruction, type of balancing procedure, BMI, specimen weight, transfusion, complications and revisions for symmetry. Statistical analysis was performed using sampled unpaired t-tests to compare BMI, specimen weight and need for PRBC transfusion.
RESULTS:The average patient age was 48 years (range 28-68 years). The majority of patients had abdominal flap reconstruction using either TRAM flaps (43 unipedicled, 23 free, 10 supercharged and 2 bipedicled,) or DIEP flaps (18). Latissimus flaps (2 with expanders, 1 with implant, and 1 alone) and tissue expanders (3) composed the remainder. The most common balancing procedure performed was reduction mammaplasty (54), followed by mastopexy (48), and breast augmentation (1). Analysis of the data revealed a significant positive correlation between BMI and specimen weight of reduction mammaplasty (p<0.05). 7.8% received transfusion, however, there was no correlation between BMI or specimen weight. Complication rates for the contralateral breast were low, and none required surgical treatment. Systemic complications were limited to one patient (DVT). Most complications were related to epidermolysis of mastectomy flaps and flap donor site healing. The overall revision rate for symmetry between the breasts was 6.8%. Two patients underwent revisions of the contralateral breast and 5 on the reconstructed breast.
CONCLUSIONS:This is the largest series to date reviewing simultaneous balancing procedures performed at the time of breast reconstruction. It demonstrates that balancing procedures can be undertaken at the time of initial reconstruction with a low revision rate, complication rate, and risk of transfusion. Although other studies have shown that transfusion rates are equal between patients undergoing simultaneous reduction mammaplasty and those that do not, some surgeons believe that larger reductions may increase the need for transfusion. This study demonstrates a significant correlation between BMI and breast reduction specimen weight, however, neither of these factors correlated with the need for transfusion. The prevailing argument for delay of contralateral balancing procedures is to allow the reconstructied breast to heal before attempting to improve symmetry. This approach requires that the patient wait several months prior to achieving symmetry, especially if adjuvant therapy is needed. Advantages to performing simultaneous balancing procedures include a single recuperative period, fewer operations, and immediate restoration of symmetry. Simultaneous contralateral balancing procedures are safe and effective and should be considered for patients undergoing breast reconstruction.