Unilateral Versus Bilateral Breast Reconstruction: Is Less Really More?
OBJECTIVE
Over the recent years, there has been an increase in prophylactic mastectomies with an associated increase in bilateral breast reconstruction. We aimed to compare outcomes in terms of patient satisfaction with unilateral versus bilateral breast reconstruction after deep inferior epigastric perforator (DIEP) flap and implant-based reconstruction.


METHODS
Patients who underwent breast reconstruction by a single surgeon between July 2011 and July 2015 were surveyed using the independently validated BREAST-Q questionnaire. Mean satisfaction scores between patients undergoing unilateral versus bilateral breast reconstruction were compared and stratified based on the type of reconstruction [eg, DIEP flap, tissue expander to implant (TE/I)]. Groups were further categorized by age (patients <55 years and ≥55 years of age) and body mass index (<24.9 and >24.9). Complications were recorded.


RESULTS
Of the 308 patients included, 118 (38%) had unilateral reconstruction (42 TE/I and 76 DIEP) and 190 (62%) had bilateral reconstruction (124 TE/I and 66 DIEP). A total of 95 patient surveys were included (31% response rate). Overall, patients receiving unilateral reconstruction demonstrated increased satisfaction with outcome (P = 0.028), psychosocial well-being (P = 0.043), and sexual well-being (P = 0.002). Complication rates were similar between unilateral and bilateral reconstruction. No significant differences for satisfaction were found in the TE/I group (N = 58; unilateral, 10; bilateral, 48).In the DIEP group (N = 37; unilateral, 20; bilateral, 17), those receiving unilateral reconstruction had higher satisfaction with outcome (P = 0.013) and sexual well-being (P = 0.014).Additionally, younger patients (<55 years) were more likely to undergo bilateral reconstruction (P = 0.018). Body mass index did not have a significant association with unilateral or bilateral reconstruction.


CONCLUSIONS
Patients undergoing DIEP flap reconstruction showed higher satisfaction with unilateral reconstruction, whereas patients receiving TE/I reconstruction, either unilateral or bilateral, were equally satisified. Additionally, younger women were more likely to undergo bilateral reconstruction, which is consistent with current data trends. When considering surgical options, unilateral DIEP flap reconstruction may provide improved outcomes in terms of patient satisfaction when compared with bilateral reconstruction in select patients.
From the *Division of Plastic Surgery, Department of Surgery, Morsani College of Medicine, †Morsani College of Medicine, and §Department of Internal Medicine, Morsani College of Medicine, University of South Florida; and ‡Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
Lauren V
LV
Kuykendall
Bugra
B
Tugertimur
Corin
C
Agoris
Sara
S
Bijan
Ambuj
A
Kumar
Deniz
D
Dayicioglu
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D019074:Epigastric Arteries / Q000601:surgery* / Q000637:transplantation; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000401:mortality; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D011379:Prognosis; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome