Synchronous Symmetrisation - An Obligatory Part of the Reconstructive Journey?
Association of Breast Surgery ePoster Library. Hamnett K. 05/15/17; 166322; P175
Mrs. Kathryn Hamnett
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Abstract
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Introduction
Recent evidence suggests that 77% of surgeons would consider contralateral synchronous symmetrisation in the context of a Therapeutic Mammaplasty (TM) or Total Breast Reconstruction (TBR) if indicated. In contrast, only 13% would never offer it. The argument for delaying symmetrisation to a planned second operation is that the final reconstructed breast will often undergo morphological change. This can be unpredictable particularly when radiotherapy is recommended. It is suspected that performing synchronous symmetrisation shortens the patient's reconstructive journey with important benefits to patient, practitioner and institution.
Methods
The aim of this study was to compare current practice and outcome of synchronous symmetrisation in both TM and TBR against best practice. Patients undergoing TM, implant or autologous TBR (including DIEP, TRAM and LD) during a ten-year period were identified. Outcome measures included: choice of symmetrising procedure, time length of operation, total number of general anaesthetics, (GAs) duration of time patient spent with gross asymmetry and length of patient journey from first to final operation.
Results
The total number of GAs were less in the synchronous group, while the delayed symmetrisation group had shorter individual operation time lengths. Patients spent less time with gross asymmetry.
Conclusion
Synchronous symmetrisation in both TM and TBR results in fewer GAs and shortens the patient reconstructive journey. Even accounting for revision surgery, less theatre operative time is utilised with an additional potential financial saving. In view of this we recommend that symmetrisation be performed at the same time as reconstruction where possible.
Recent evidence suggests that 77% of surgeons would consider contralateral synchronous symmetrisation in the context of a Therapeutic Mammaplasty (TM) or Total Breast Reconstruction (TBR) if indicated. In contrast, only 13% would never offer it. The argument for delaying symmetrisation to a planned second operation is that the final reconstructed breast will often undergo morphological change. This can be unpredictable particularly when radiotherapy is recommended. It is suspected that performing synchronous symmetrisation shortens the patient's reconstructive journey with important benefits to patient, practitioner and institution.
Methods
The aim of this study was to compare current practice and outcome of synchronous symmetrisation in both TM and TBR against best practice. Patients undergoing TM, implant or autologous TBR (including DIEP, TRAM and LD) during a ten-year period were identified. Outcome measures included: choice of symmetrising procedure, time length of operation, total number of general anaesthetics, (GAs) duration of time patient spent with gross asymmetry and length of patient journey from first to final operation.
Results
The total number of GAs were less in the synchronous group, while the delayed symmetrisation group had shorter individual operation time lengths. Patients spent less time with gross asymmetry.
Conclusion
Synchronous symmetrisation in both TM and TBR results in fewer GAs and shortens the patient reconstructive journey. Even accounting for revision surgery, less theatre operative time is utilised with an additional potential financial saving. In view of this we recommend that symmetrisation be performed at the same time as reconstruction where possible.
Introduction
Recent evidence suggests that 77% of surgeons would consider contralateral synchronous symmetrisation in the context of a Therapeutic Mammaplasty (TM) or Total Breast Reconstruction (TBR) if indicated. In contrast, only 13% would never offer it. The argument for delaying symmetrisation to a planned second operation is that the final reconstructed breast will often undergo morphological change. This can be unpredictable particularly when radiotherapy is recommended. It is suspected that performing synchronous symmetrisation shortens the patient's reconstructive journey with important benefits to patient, practitioner and institution.
Methods
The aim of this study was to compare current practice and outcome of synchronous symmetrisation in both TM and TBR against best practice. Patients undergoing TM, implant or autologous TBR (including DIEP, TRAM and LD) during a ten-year period were identified. Outcome measures included: choice of symmetrising procedure, time length of operation, total number of general anaesthetics, (GAs) duration of time patient spent with gross asymmetry and length of patient journey from first to final operation.
Results
The total number of GAs were less in the synchronous group, while the delayed symmetrisation group had shorter individual operation time lengths. Patients spent less time with gross asymmetry.
Conclusion
Synchronous symmetrisation in both TM and TBR results in fewer GAs and shortens the patient reconstructive journey. Even accounting for revision surgery, less theatre operative time is utilised with an additional potential financial saving. In view of this we recommend that symmetrisation be performed at the same time as reconstruction where possible.
Recent evidence suggests that 77% of surgeons would consider contralateral synchronous symmetrisation in the context of a Therapeutic Mammaplasty (TM) or Total Breast Reconstruction (TBR) if indicated. In contrast, only 13% would never offer it. The argument for delaying symmetrisation to a planned second operation is that the final reconstructed breast will often undergo morphological change. This can be unpredictable particularly when radiotherapy is recommended. It is suspected that performing synchronous symmetrisation shortens the patient's reconstructive journey with important benefits to patient, practitioner and institution.
Methods
The aim of this study was to compare current practice and outcome of synchronous symmetrisation in both TM and TBR against best practice. Patients undergoing TM, implant or autologous TBR (including DIEP, TRAM and LD) during a ten-year period were identified. Outcome measures included: choice of symmetrising procedure, time length of operation, total number of general anaesthetics, (GAs) duration of time patient spent with gross asymmetry and length of patient journey from first to final operation.
Results
The total number of GAs were less in the synchronous group, while the delayed symmetrisation group had shorter individual operation time lengths. Patients spent less time with gross asymmetry.
Conclusion
Synchronous symmetrisation in both TM and TBR results in fewer GAs and shortens the patient reconstructive journey. Even accounting for revision surgery, less theatre operative time is utilised with an additional potential financial saving. In view of this we recommend that symmetrisation be performed at the same time as reconstruction where possible.
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