Impact of Contralateral Symmetry Procedures on Long-Term Patient-Reported Outcomes following Unilateral Prosthetic Breast Reconstruction

Abstract

Background One aim of unilateral postmastectomy breast reconstruction (BR) is to restore symmetry with the contralateral breast. As such, unilateral prosthetic reconstruction often requires a contralateral symmetry procedure (CSP). There is sparse literature on the impact of CSPs on long-term patient-reported outcomes (PROs) such as satisfaction and health-related quality of life (HRQoL). This study aims to describe PROs following CSPs, using a validated PRO tool, BREAST-Q. The hypothesis is that CSPs are associated with greater patient-reported satisfaction and HRQoL.

Methods This study is a single institutional analysis of prospectively collected BREAST-Q scores of patients who underwent unilateral prosthetic BR during 2011 to 2015. Women 18 years and older with BREAST-Q scores measured ≥ 9months after BR with or without CSP(s) at the time of expander replacement were included. Patients were classified into four subcohorts: augmentation, mastopexy, reduction, and no symmetry procedure (controls). Sociodemographic, clinical characteristics, and BREAST-Q scores were analyzed. Multivariable linear regression was performed.

Results Of 553 patients, 67 (12%) underwent contralateral augmentation, 68 (12%) mastopexy, 93(17%) reduction, and 325 (59%) were controls. Mean follow-up time was 52 months. Satisfaction with breast and outcomes were higher in the augmentation compared with the control groups (p = 0.01). On multivariable analysis, augmentation remained an independent predictor of satisfaction with breast (p = 0.04). Physical well-being scores were lower for contralateral mastopexy and reduction compared with the controls with a trend toward statistical significance on multivariable models. Psychological and sexual well-being was similar across groups.

Conclusion Prosthetic reconstruction with contralateral breast augmentation was associated with greater satisfaction with breast and reconstructive outcome. In contrast, breast reduction and mastopexy procedures demonstrated equivalent satisfaction with breasts compared with controls but may be associated with lower physical well-being. Such information can be used to improve the shared decision-making process for women who choose unilateral prosthetic BR.

Keywords

BREAST-Q - contralateral symmetry procedure - unilateral prosthetic breast reconstruction

Financial Disclosure

The BREAST-Q is jointly owned by Memorial Sloan Kettering Cancer Center and the University of British Colombia. Andrea L. Pusic, MD, MHS, is a codeveloper of the BREAST-Q, and, as such, received a share of any license revenue based on the inventor sharing policies of these two institutions. The BREAST-Q is provided free of charge for academic research and use in clinical practice by health care providers with individual patients. The scoring software, Q-Score, is also offered free of charge to all BREAST-Q users at https://webcore.mskcc.org/breastq/. None of the other authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Conference Proceedings

Abstract of this work was presented at the annual meeting of the American Society for Reconstructive Microsurgery, Waikoloa, Hawaii, January 2017.

^* These authors made an equal contribution to this article.

• References

• 1 Rizki H, Nkonde C, Ching RC, Kumiponjera D, Malata CM. Plastic surgical management of the contralateral breast in post-mastectomy breast reconstruction. Int J Surg 2013; 11 (09) 767-772
• 2 Nahabedian MY. Managing the opposite breast: contralateral symmetry procedures. Cancer J 2008; 14 (04) 258-263
• 3 Nahabedian MY. Symmetrical breast reconstruction: analysis of secondary procedures after reconstruction with implants and autologous tissue. Plast Reconstr Surg 2005; 115 (01) 257-260
• 4 Losken A, Carlson GW, Bostwick III J, Jones GE, Culbertson JH, Schoemann M. Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience. Plast Reconstr Surg 2002; 110 (01) 89-97
• 5 Cooney CM, Sebai ME, Ogbuagu O, Devulapalli C, Manahan MA, Rosson GD. Matching procedures at the time of immediate breast reconstruction: an American College of Surgeons National Surgical Quality Improvement Program Study of 24,191 patients. Plast Reconstr Surg 2016; 138 (06) 959e-968e
• 6 Mathew J, Courtney CA. Symmetrisation procedures in breast reconstruction patients constitute a rising workload in our DGH. Surgeon 2014; 12 (06) 307-309
• 7 Cogliandro A, Brunetti B, Barone M, Favia G, Persichetti P. Management of contralateral breast following mastectomy and breast reconstruction using a mirror adjustment with crescent mastopexy technique. Breast Cancer 2018; 25 (01) 94-99
• 8 Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124 (02) 345-353
• 9 Campbell KL, Pusic AL, Zucker DS. , et al. A prospective model of care for breast cancer rehabilitation: function. Cancer 2012; 118 (8, Suppl): 2300-2311
• 10 Bar-Meir ED, Lin SJ, Momoh AO. , et al. The lateral chest wall: a separate aesthetic unit in breast surgery. Plast Reconstr Surg 2011; 128 (06) 626e-634e
• 11 Liu HH, Chiang IH, Wang CH. , et al. Postmastectomy breast reconstruction combined with contralateral breast augmentation for Taiwanese women with small breasts. Ann Plast Surg 2017; 78 (03) (Suppl. 02) S102-S107
• 12 Barone M, Cogliandro A, Signoretti M, Persichetti P. Analysis of symmetry stability following implant-based breast reconstruction and contralateral management in 582 patients with long-term outcomes. Aesthetic Plast Surg 2018; 42 (04) 936-940