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Impact of Unilateral versus Bilateral Breast Reconstruction on Procedure Choices and Outcomes

Taylor, Erin M. M.D.; Wilkins, Edwin G. M.D., M.S.; Pusic, Andrea L. M.D., M.H.S.; Qi, Ji M.S.; Kim, Hyungjin Myra Sc.D.; Hamill, Jennifer B. M.P.H.; Guldbrandsen, Gretchen E. B.A.; Chun, Yoon S. M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1159e-1168e
doi: 10.1097/PRS.0000000000005602
Breast: Original Articles
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Background: In choosing between implant-based and autologous breast reconstruction, surgeons and patients must weigh relative risks and benefits. However, differences in outcomes across procedure types may vary between unilateral versus bilateral reconstructions. Procedure-related differences in complications and patient-reported outcomes were evaluated for unilateral and bilateral reconstruction.

Methods: Complications and patient-reported outcomes (BREAST-Q and Patient-Reported Outcomes measurement Information System surveys) were assessed at 2 years for patients undergoing autologous or implant-based reconstructions. Stratified regression models compared outcomes between autologous and implant-based reconstructions, separately for unilateral and bilateral cohorts.

Results: Among 2125 patients, 917 underwent unilateral (600 implant and 317 autologous) and 1208 underwent bilateral (994 implant and 214 autologous) reconstructions. Complication rates were significantly higher in the autologous versus implant-based group for both unilateral (overall: OR, 2.50, p < 0.001; major: OR, 2.19, p = 0.001) and bilateral (overall: OR, 2.13, p < 0.001; major: OR, 1.69, p = 0.014) cohorts. In unilateral reconstruction, the autologous group demonstrated significantly better patient-reported outcomes versus implant-based group in satisfaction with breast (mean difference, 9.85; p < 0.001), psychosocial well-being (mean difference, 4.84; p = 0.006), and sexual well-being (mean difference, 11.42; p < 0.001). In bilateral reconstruction, the autologous group demonstrated significantly higher patient-reported outcomes only for satisfaction with breast (mean difference, 5.13; p = 0.001).

Conclusions: Although autologous reconstruction is associated with significantly better patient-reported outcomes compared to implant-based techniques in unilateral reconstruction, procedure choice has far less impact in bilateral reconstruction. Autologous procedures have higher complications rates in both unilateral and bilateral settings.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Boston, Mass.; Ann Arbor, Mich.; and New York, N.Y.

From the Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital; the Section of Plastic Surgery and the Department of Biostatistics, University of Michigan Medical School; and the Memorial Sloan Kettering Cancer Center.

Received for publication March 1, 2018; accepted July 26, 2018.

Presented at the 97th Annual Meeting of the American Association of Plastic Surgeons, in Seattle, Washington, April 7 through 10, 2018.

Disclosure:The BREAST-Q is owned by Memorial Sloan Kettering Cancer Center and the University of British Columbia. Dr. Pusic is a co-developer of the BREAST-Q and receives royalties when it is used in for-profit industry-sponsored clinical trials. No other authors have any conflicts of interests to disclose.

Yoon S. Chun, M.D., Brigham and Women’s Hospital, 75 Francis Street, Boston, Mass. 02115, ychun@bwh.harvard.edu

Copyright © 2019 by the American Society of Plastic Surgeons