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
