title: Achieving symmetry in unilateral breast reconstruction: 17 years experience with 683 patients.
abstract: Breast symmetry is one of the most important parameters of patient satisfaction in breast reconstruction. We undertook this retrospective study to determine whether autologous reconstruction requires opposite-breast procedures less often to achieve symmetry than do non-autologous techniques. The records of 683 patients who underwent delayed breast reconstruction between March 1983 and March 2000 were reviewed. Two hundred and twelve patients (31%) received a TRAM flap, 167 (24%) received a latissimus dorsi myocutaneous flap plus implant (LD), and 304 patients (45%) underwent saline-filled implant (I) reconstruction. The type of opposite surgery was analyzed and compared among groups. An inverted-T breast reduction or mastopexy was performed with equal frequency in the three groups (respectively, 33.5%, 37.8%, and 27.6%). Mastopexy using a circumareolar technique was less frequently performed in the TRAM group (1.9%) than in the other two groups (5.3% and 8.2%, respectively; p = 0.012). Breast augmentation was essentially performed in the LD (30.5%) and I (21.7%) groups, and the difference was statistically significant (p = 0.03). Only one patient of the TRAM group underwent augmentation mammaplasty. The total prevalence of opposite breast procedures was different between the TRAM group (35.5%) and the other two groups (67% in the LD group and 54.6% in the I group; p = 0.001). Our study clearly demonstrates that TRAM flap breast reconstruction more frequently matches the opposite breast, thus avoiding additional surgery to achieve symmetry, in comparison with implant-based techniques.
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Arnaud de Villeneuve, Montpellier, France. pl-Giacalone@wanadoo.fr
authors.forename: Pierre-Ludovic
authors.initials: PL
authors.lastname: Giacalone
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bricout
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Dantas
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Daurés
authors.forename: Francois
authors.initials: F
authors.lastname: Laffargue
mesh_terms: D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies