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Patient Satisfaction in Unilateral and Bilateral Breast Reconstruction [Outcomes Article]

Craft, Randall O. M.D.; Colakoglu, Salih M.D.; Curtis, Michael S. M.D.; Yueh, Janet H. M.D.; Lee, Britt S. M.D., Ph.D.; Tobias, Adam M. M.D.; Lee, Bernard T. M.D.

Plastic and Reconstructive Surgery: April 2011 - Volume 127 - Issue 4 - p 1417-1424
doi: 10.1097/PRS.0b013e318208d12a
Breast: Original Articles

Background: The goal of reconstruction after mastectomy is to provide a long-term and symmetric reconstruction. Providing symmetry entails different decision making when faced with a unilateral or bilateral reconstruction. In unilateral reconstruction, the goal is to match the contralateral breast; however, in bilateral reconstruction, symmetry between the reconstructed breasts is more important. The purpose of this study was to examine patient satisfaction between unilateral and bilateral reconstruction.

Methods: All women at Beth Israel Deaconess Medical Center undergoing breast reconstruction between 1999 and 2006 were identified. Patient demographics and complications were collected. A survey was administered examining general and aesthetic satisfaction. Patients with unilateral reconstruction were identified and compared with patients with bilateral reconstruction. Additional analysis was performed based on the type of reconstruction, including autologous, autologous with implant, and tissue expander/implant-based reconstruction.

Results: Overall, 702 women underwent 910 breast reconstructions (494 unilateral, 416 bilateral). Patients in the bilateral reconstruction group were more likely to have prophylactic mastectomy and immediate reconstruction. Complication rates were similar between unilateral and bilateral reconstruction. Patient satisfaction was highest in unilateral patients with autologous compared with implant reconstruction (general satisfaction, 73.9 versus 40.9 percent, p < 0.0001; aesthetic satisfaction, 72.3 versus 43.2 percent, p < 0.0001). Bilateral reconstruction had similar general and aesthetic satisfaction scores across autologous, autologous with implant, and implant-based reconstruction.

Conclusions: Patients undergoing unilateral reconstruction have the highest satisfaction with autologous reconstruction. As symmetry between reconstructed breasts is essential for patient satisfaction in bilateral reconstruction, it is important to use the same type of reconstruction, whether autologous or implant-based.

Boston, Mass.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.

Received for publication August 8, 2010; September 20, 2010.

Disclosure:The authors have no financial interests in this research project or in any of the techniques or equipment used in this study. The authors have no conflicts of interest to disclose.

Bernard T. Lee, M.D., Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 5A, Boston, Mass. 02215,

©2011American Society of Plastic Surgeons