Simultaneous Symmetrizing Surgery on the Contralateral Breast in Unilateral Autologous Breast Reconstruction is Cost-Effective.

BACKGROUND Simultaneous symmetrizing surgery 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 2017-2021 and followed for one year. Patients were stratified by immediate and delayed reconstruction, then further stratified into groups with simultaneous symmetrizing surgery and without simultaneous symmetrizing surgery. Thirty-day complications included transfusion, wound dehiscence, surgical site infection, hematoma/seroma and thromboembolism. 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 1136 patients were identified. 638 were delayed reconstructions: 75 with simultaneous symmetrizing surgery and 563 without. There were no significant differences in patient characteristics or 30-day complications. Within one year of index reconstruction, fewer patients with simultaneous symmetrizing surgery underwent a revision surgery (29% vs 51%, (p=0.001)) or at least one additional procedure (36% vs 57%, p<0.001). Patients with simultaneous symmetrizing surgery had lower total costs ($35,897 vs $50,521, p=0.005). There were 498 immediate reconstructions: 63 with simultaneous symmetrizing surgery 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 cost and number of subsequent surgeries without increasing complications.