Bilateral Implant Breast Reconstruction Outcomes, Predictors, and Matched Cohort Analysis in 730 2-Stage Breast Reconstructions Over 10 Years

Background: Rates of bilateral implant breast reconstruction (BI/BR) are rising despite the lack of precise information. Previous studies have examined unilateral reconstruction, making it difficult to counsel patients regarding the risk of BI/BR. The purpose of this study was to identify the incidence of complications and predictors of unfavorable aesthetic outcomes in the largest study to date of exclusive 2-stage BI/BR. Furthermore, a novel matched cohort analysis was conducted in patients who underwent contralateral prophylactic mastectomy and therapeutic mastectomy, whereby each patient acts as her own perfect internal control. Methods: A retrospective chart review of consecutive patients who underwent BI/BR from 1997 to 2007 was performed to obtain patient demographics, treatment, and outcomes. Univariate and multivariate logistic regression analyses were performed to determine risk factors leading to the development of unfavorable aesthetic outcomes. W 2 test and Fisher exact analysis were used for matched-pairs analysis. Results: Seven hundred thirty 2-stage BI/BRs were performed in 365 patients; perioperative complication rates were low at 9.3%. Long-term outcomes/unfavorable aesthetics were rippling (12.7%), capsular contracture (8.4%), and malposition (7.8%). After regression analysis, age [odds ratio (OR), 1.05], radiation (OR, 4.27), and length of follow-up (OR, 1.48) were significantly associated with capsular contracture. Radiation (OR, 0.26) and body mass index (OR, 0.95) were inversely associated with rippling. In the matched cohort, complication rates were similar between sides with malposition and rippling as significantly different aesthetic outcomes (P < 0.05). Adjusted individual complication rates in the bilateral cohort of 18.4% were comparable with previous mixed and majority unilateral cohorts in the literature. Conclusions: Bilateral implant breast reconstruction has become increasingly prevalent for patients with breast cancer. Overall complications are low; BI/BR does not appear to incur additive risk. Matched cohort analysis confirmed low complication rates with only malposition and rippling as significant differences between sides.