title: The efficacy of simultaneous breast reconstruction and contralateral balancing procedures in reducing the need for second stage operations.
abstract: BACKGROUND
  Patients having unilateral breast reconstruction often require a second stage procedure on the contralateral breast to improve symmetry. In order to provide immediate symmetry and minimize the frequency and extent of secondary procedures, we began performing simultaneous contralateral balancing operations at the time of initial reconstruction. This study examines the indications, safety, and efficacy of this approach.
  
  
  METHODS
  One-hundred and two consecutive breast reconstructions with simultaneous contralateral balancing procedures were identified. Data included patient age, body mass index (BMI), type of reconstruction and balancing procedure, specimen weight, transfusion requirement, complications and additional surgery under anesthesia. Unpaired t-tests were used to compare BMI, specimen weight and need for non-autologous transfusion.
  
  
  RESULTS
  Average patient age was 48 years. The majority had autologous tissue-only reconstructions (94%) and the rest prosthesis-based reconstructions (6%). Balancing procedures included reduction mammoplasty (50%), mastopexy (49%), and augmentation mammoplasty (1%). Average BMI was 27 and average reduction specimen was 340 grams. Non-autologous blood transfusion rate was 9%. There was no relationship between BMI or reduction specimen weight and need for transfusion. We performed secondary surgery in 24% of the autologous group and 100% of the prosthesis group. Revision rate for symmetry was 13% in the autologous group and 17% in the prosthesis group.
  
  
  CONCLUSIONS
  Performing balancing at the time of breast reconstruction is safe and most effective in autologous reconstructions, where 87% did not require a second operation for symmetry.
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Smith
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Clarke-Pearson
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Vornovitsky
authors.affiliation: Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Dayan
authors.affiliation: Department of Surgery, Mount Sinai St. Luke's-Roosevelt, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Samson
authors.affiliation: Department of Surgery, Mount Sinai St. Luke's-Roosevelt, New York, NY, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Sultan
keywords: Breast neoplasms; Free tissue flaps; Mammoplasty