title: Contralateral breast symmetrisation in unilateral DIEP flap breast reconstruction.
abstract: BACKGROUND
  Women undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction may be offered a contralateral symmetrisation either at the time of reconstruction (simultaneous/immediate) or at a later stage (delayed). Simultaneous contralateral breast symmetrisation may be more beneficial to patients and healthcare institutions by avoiding staged surgery, although there is limited evidence on which to base practice. This deficit formed the rationale for our study. The primary outcome was the overall rate of revision surgery.
  
  
  METHODS
  Over a 6-year period, this prospective cohort study recorded the demographics, cancer treatments and operative outcomes of all consecutive unilateral DIEP flap breast reconstructions with or without contralateral symmetrising surgery. Patients were categorised into three groups: (1) simultaneous symmetrisation, 2) delayed symmetrisation and (3) no symmetrisation for comparative analysis.
  
  
  RESULTS
  During the study period, 371 women underwent unilateral DIEP flap breast reconstruction 194 (52.3%) were not symmetrised, 155 (41.8%) were simultaneously symmetrised and 22 (5.9%) underwent delayed symmetrisation. Simultaneous symmetrisation of the contralateral breast and unilateral DIEP flap breast reconstruction increased the mean total operative time by 28 min. There were no differences in the rates of peri-operative complications. There were significantly higher rates of all-cause revision surgery (OR 3.97 [1.58, 9.94], p = 0.003) in women undergoing delayed symmetrisation, because of higher rates of revision lipomodelling, scar revision and revision contralateral symmetrisation.
  
  
  CONCLUSIONS
  Simultaneous contralateral breast symmetrisation was associated with a lower risk of all-cause revision surgery. It is safe, beneficial and likely to be more cost-effective for women undergoing unilateral free DIEP flap breast reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK; The School of Medicine, University of Leeds, Leeds, UK.
authors.forename: Ryckie G
authors.initials: RG
authors.lastname: Wade
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marongiu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Sassoon
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Haywood
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Rozina S
authors.initials: RS
authors.lastname: Ali
authors.affiliation: Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK; Faculty of Medicine and Health Sciences, Norwich Medical School, Department of Medical Education, University of East Anglia, UK. Electronic address: andrea.figus@nnuh.nhs.uk.
authors.forename: Andrea
authors.initials: A
authors.lastname: Figus
mesh_terms: D000368:Aged; D001940:Breast / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000379:methods; D019074:Epigastric Arteries / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods / Q000534:rehabilitation; D008875:Middle Aged; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D061525:Perforator Flap / Q000098:blood supply*; D011446:Prospective Studies; D000069584:Unilateral Breast Neoplasms / Q000601:surgery*; D006113:United Kingdom
keywords: Breast reconstruction; Complications; DIEP; Delayed; Immediate; Symmetrisation