Plastic & Reconstructive Surgery: June 2015 - Volume
135 - Issue 6 - p 946e–953e
doi: 10.1097/PRS.0000000000001233
Chang, Edward I. et al
Background: There is an increasing
trend for contralateral prophylactic mastectomy, but studies focusing on
bilateral free flap breast reconstruction are lacking.
Methods: A retrospective review was
performed of all bilateral free flap breast reconstructions performed from 2000
to 2010.
Results: Overall, 488 patients
underwent bilateral breast reconstruction (bilateral immediate, n = 283;
bilateral delayed, n = 93; and bilateral immediate/delayed, n = 112), which
more than doubled from the years 2000–2005 to 2006–2010 [147 versus 341 (232.0
percent)]. Comparison of contralateral prophylactic mastectomy demonstrated a
similar increase over the decade [139 versus 282 (203.9 percent)]. There was an
increasing trend toward perforator flaps [70 versus 203 (290 percent)] compared
to traditional transverse rectus abdominis myocutaneous flaps [99 versus 17 (17
percent)] between the first and second halves of the decade. Patients
undergoing a bilateral immediate/delayed reconstruction were significantly more
likely to undergo a revision (p = 0.05), particularly on the immediate
reconstructed breast (OR, 1.59; p = 0.05). Delayed reconstruction and obesity
were significantly associated with postoperative complications. Obesity,
smoking, and radiation therapy significantly increased fat necrosis rates, 2.77
(p = 0.01), 2.31 (p = 0.03), and 2.38 times (p = 0.03), respectively. In
comparison to unilateral reconstruction, bilateral reconstruction had
significantly higher flap loss rates (p = 0.004), comparable donor-site complications,
and equivalent rates of revisions.
Conclusions: There has been an increase in
bilateral free flap breast reconstruction. Bilateral immediate/delayed
reconstruction had higher revision rates of the prophylactic breast to achieve
symmetry. Obesity, smoking, and radiation therapy were associated with
increased complications, including fat necrosis, but successful reconstruction
can be achieved with acceptable risks.
