Symmetrical breast surgery: balancing procedures versus prophylactic mastectomy and immediate reconstruction

BACKGROUND

Various techniques for management of the contralateral breast exist in patients with unilateral breast cancer including contralateral prophylactic mastectomy with immediate breast reconstruction (PMIBR), or symmetrisation techniques including augmentation, reduction, or mastopexy. The purpose of this prospective cohort study was to evaluate and compare complications and patient-reported satisfaction of patients with contralateral PMIBR versus having symmetrisation procedures.

METHODS

A 7-year, single institution, prospectively maintained data base was reviewed. Patient-reported BREAST-Q were obtained at baseline, 3-months, and 12-months prospectively. Post-operative complications, oncologic outcomes and BREAST-Q scores were compared.

RESULTS

249 patients were included, 93 (37%) of which had contralateral PMIBR and 156 (63%) which had contralateral symmetrisation. The patients who underwent PMIBR were younger and had less co-morbidities compared to patients with symmetrisation. Rates of major and minor complications were similar apart from higher rates of minor wound dehiscence in the PMIBR group. When comparing mean change at 12 months follow up to pre-operative results, there was a significant decrease in the physical well-being of chest in the symmetrisation compared to PMIBR group (2.94 vs. -5.69, p=0.042). There were no significant differences in mean breast satisfaction, psychosocial well-being, and non-significant decreases in sexual well-being between groups.

CONCLUSION

Patients with unilateral breast cancer who underwent immediate contralateral breast management, with either contralateral PMIBR or symmetrisation techniques, demonstrated similar profiles of major complications and good overall satisfaction except one physical well-being domain. Management of the contralateral breast with symmetrisation may provide similar outcomes compared to PMIBR, which often is considered not necessary in patients without specific indications.

Patient-reported outcomes following free flap lower extremity reconstruction: A systematic review and meta-analysis

PURPOSE

Free flap reconstruction in the lower extremity has shown success for the management of large and complex defects, restoration of function, and favorable aesthetic outcomes. Patient-reported outcomes (PROs) have not been well explored in previous literature. This meta-analysis aimed to provide a comprehensive summary of PROs after free flap reconstruction in the lower extremity.

METHODS

We searched MEDLINE and Embase from 1946 to 2021 for studies reporting on PROs following free flap reconstruction in the lower extremity.

RESULTS

Overall, 53 studies were included, and 11 studies reported validated PRO measures for meta-analysis. A total of 1953 patients underwent reconstruction with 1958 free flaps for lower limb defects with a mean follow-up of 3.26 (0.25-7.83) months. The mean postoperative Lower Extremity Functional Scale (LEFS) scores were 60.3 (±12) out of 80 points (4 studies, 85 patients). The mean postoperative AOFAS scores were 75.1 (±15) out of 100 points (4 studies, 68 patients). The mean postoperative SF-36 scores were 88.1 (±8.0) out of 100 points; mental health component was 48.7 (±8.9), and physical component was 38.4 (±8.2), out of 50 points (4 studies, 88 patients).

CONCLUSION

Our findings demonstrated that patients report improved physical health, mental health, and function following lower extremity reconstruction with free flaps. Patients reported similar improvements in functional scores following lower extremity reconstruction regardless of their free flap type. Furthermore, patients with myocutaneous flaps may have improved mental health and worse physical health scores when compared to perforator flaps. The evidence profiles presented in this review indicate that additional research is needed to help guide future decision-making.