Simultaneous Free Flap Breast Reconstruction Combined with Contralateral Mastopexy or Breast Reduction: A Propensity Matched NSQIP Study on Postoperative Outcomes
Cindy Gombaut*, Melanie Bakovic, Hoang-Viet Tran, Bharat Ranganath
George Washington School of Medicine and Health Sciences, Washington,
Simultaneous free flap breast reconstruction combined with contralateral mastopexy or breast reduction can increase patient satisfaction and minimize the need for a second procedure. Surgeon concerns of increases in operative time, postoperative complications, and final breast symmetry may decrease the likelihood of these procedures being done concurrently. This study analyzed postoperative outcomes of simultaneous contralateral mastopexy or breast reduction with free flap breast reconstruction.
By using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2010-2020), we analyzed two patient cohorts undergoing (A) free flap breast reconstruction only and (B) free flap breast reconstruction combined with contralateral mastopexy or breast reduction. The preoperative variables assessed included demographic data, comorbidities, and perioperative data. Using a neighbor matching algorithm, we performed a 1:1 propensity score matching of 602 free flap breast reconstruction patients and 621 with concurrent contralateral operation patients. Bivariate analysis for postoperative surgical and medical complications was performed for outcomes in the propensity-matched cohort.
We identified 11,308 cases who underwent microsurgical free flap breast reconstruction from the ACS-NSQIP database from the beginning of 2010 to the end of 2020. A total of 621 patients underwent a free flap breast reconstruction combined with contralateral mastopexy or breast reduction. After propensity-score matching, there were no significant differences in patient characteristics, perioperative variables, or postoperative medical complications between the two cohorts.
Simultaneous free flap breast reconstruction combined with contralateral mastopexy or breast reduction can be performed in patients with no increase in postoperative complication rates. The combination of these procedures can provide symmetrical, aesthetically pleasing results to breast cancer survivors with minimal complications, reduced costs, and elimination of a second operation.
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