Impact of Unilateral versus Bilateral Breast Reconstruction on Procedure Choices and Outcomes

BACKGROUND: In choosing between implant-based and autologous breast reconstruction, surgeons and patients must weigh relative risks and benefits. However, differences in outcomes across procedure types may vary between unilateral versus bilateral reconstructions. Procedure-related differences in complications and patient-reported outcomes (PROs) were evaluated for unilateral and bilateral reconstruction. METHODS: Complications and PROs were assessed at two years for patients undergoing autologous (TRAM, DIEP, SIEA) or implant-based (TE, DTI) reconstructions. Overall complications and major complications (requiring re-admission and/or re-operation) were recorded, while PROs were measured with BREAST-Q and PROMIS surveys. Stratified regression models compared outcomes between autologous and implant-based reconstructions, separately for unilateral and bilateral cohorts. RESULTS: Among 2125 patients, 917 underwent unilateral (600 implant, 317 autologous) and 1208 underwent bilateral (994 implant, 214 autologous) reconstructions. Controlling for patient characteristics, complication rates were significantly higher in the autologous versus implant-based group with both unilateral (overall: OR 2.50, p