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J Reconstr Microsurg
DOI: 10.1055/a-2517-0803
Original Article

Simultaneous Symmetrizing Surgery on the Contralateral Breast in Unilateral Autologous Breast Reconstruction Is Cost-Effective

K. Lynn Zhao 
1   Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
,
Alexander J. Kammien
1   Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
,
Elena Graetz
2   Health Outcomes and Research Center, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
,
Miranda S. Moore
2   Health Outcomes and Research Center, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
,
Brogan G. Evans
1   Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
,
Eric B. Schneider
2   Health Outcomes and Research Center, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
,
Haripriya S. Ayyala 
1   Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
› Institutsangaben Fundings None.
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Abstract

Background Simultaneous symmetrizing surgery (SSS) at the time of unilateral free flap reconstruction has been described as a method to facilitate single-stage breast reconstruction. However, the impact on cost and number of additional procedures is not well described.

Methods Patients with unilateral free flap reconstruction were identified in national administrative data from 2017 to 2021 and followed for one year. Patients were stratified by immediate and delayed reconstruction, then further stratified into groups with and without SSS. Thirty-day complications included transfusion, wound dehiscence, surgical site infection, hematoma/seroma, and thromboembolism. The costs of initial hospitalization and subsequent surgeries were determined. Deferred symmetrizing surgeries within one year were identified. Chi-squared and Fisher exact tests and Wilcoxon tests were used for statistical analysis.

Results A total of 1,136 patients were identified, out of which 638 were delayed reconstructions: 75 with SSS and 563 without. There were no significant differences in patient characteristics or 30-day complications. Within one year of index reconstruction, fewer patients with SSS underwent revision surgery (29% vs. 51%, [p = 0.001]) or at least one additional procedure (36% vs. 57%, p < 0.001). Patients with SSS had lower total costs ($35,897 vs. $50,521, p = 0.005). There were 498 immediate reconstructions: 63 with SSS and 435 without. There were no significant differences in patient characteristics, 30-day complications, subsequent surgeries, or total costs.

Conclusion Symmetrizing procedures at the time of unilateral reconstruction may decrease the cost and number of subsequent surgeries without increasing complications.

Keywords

breast reconstruction - free flap - cost of reconstruction

Supplementary Material



Publikationsverlauf

Eingereicht: 03. Oktober 2024

Angenommen: 30. Dezember 2024

Accepted Manuscript online:
16. Januar 2025

Artikel online veröffentlicht:
10. Februar 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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