Impact of Unilateral versus Bilateral Breast Reconstruction on Procedure Choices and Outcomes
Erin M. Taylor, M.D.1, Edwin G. Wilkins, M.D.2, Andrea L. Pusic, M.D., M.H.S.3, Ji Qi, M.S.2, Hyungjin Myra Kim, Sc.D.2, Jennifer B. Hamill, M.P.H.2, Gretchen E. Guldbrandsen, B.A.4, Yoon S. Chun, M.D.4.
1Harvard Plastic Surgery Residency Program, Boston, MA, USA, 2University of Michigan Medical School, Ann Arbor, MI, USA, 3Memorial Sloan Kettering Cancer Center, New York, NY, USA, 4Brigham and Women's Hospital, Boston, MA, USA.
PURPOSE: In choosing between implant-based and autologous breast reconstruction, surgeons and patients commonly weigh relative risks and benefits. However, differences in outcomes across procedure types may vary for unilateral and bilateral reconstructions. We evaluated procedure differences in complications and patient-reported outcomes (PROs) stratified by unilateral versus bilateral reconstruction.
METHODS: Complications and PROs were assessed at two-years for patients undergoing autologous (TRAM, DIEP, SIEA) or implant-based (TE, DTI) reconstructions at 11 centers. Overall and major (requiring re-admission/re-operation) complications were recorded, while PROs were measured with BREAST-Q and PROMIS surveys. Stratified regression models compared outcomes between autologous and implant-based reconstructions within unilateral and bilateral cohorts.
RESULTS: Among 2125 patients, 917 underwent unilateral (600 implant, 317 autologous) and 1208 underwent bilateral (994 implant, 214 autologous) reconstructions. Complication rates were significantly higher in the autologous versus implant-based group within both unilateral (overall: OR 2.50, p<0.001; major: OR 2.19, p=0.001) and bilateral (overall: OR 2.13, p<0.001; major: OR 1.69, p=0.014) cohorts. In unilateral reconstruction, the autologous group demonstrated significantly better PROs compared to the implant-based group in satisfaction with breast (mean difference=9.85, p<0.001), psychosocial well-being (mean difference=4.84, p=0.006), and sexual well-being (mean difference=11.42, p<0.001). In bilateral reconstruction, the autologous group demonstrated significantly higher PROs only for satisfaction with breast (mean difference=5.13, p=0.001).
CONCLUSION: Although autologous reconstruction is associated with significantly better PROs compared to implant-based techniques in unilateral reconstruction, procedure choice appears to have far less impact on PROs in bilateral reconstruction. Autologous procedures have higher complications rates in both unilateral and bilateral settings.
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