{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:57:48Z","timestamp":1778687868018,"version":"3.51.4"},"reference-count":47,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Simultaneous symmetrizing surgery (SSS) 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.<\/jats:p><jats:p>Patients with unilateral free flap reconstruction were identified in national administrative data from 2017 to 2021 and followed for one year. Patients were stratified by immediate and delayed reconstruction, then further stratified into groups with and without SSS. Thirty-day complications included transfusion, wound dehiscence, surgical site infection, hematoma\/seroma, and thromboembolism. The 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.<\/jats:p><jats:p>A total of 1,136 patients were identified, out of which 638 were delayed reconstructions: 75 with SSS and 563 without. There were no significant differences in patient characteristics or 30-day complications. Within one year of index reconstruction, fewer patients with SSS underwent revision surgery (29% vs. 51%, [p\u2009=\u20090.001]) or at least one additional procedure (36% vs. 57%, p\u2009&lt;\u20090.001). Patients with SSS had lower total costs ($35,897 vs. $50,521, p\u2009=\u20090.005). There were 498 immediate reconstructions: 63 with SSS and 435 without. There were no significant differences in patient characteristics, 30-day complications, subsequent surgeries, or total costs.<\/jats:p><jats:p>Symmetrizing procedures at the time of unilateral reconstruction may decrease the cost and number of subsequent surgeries without increasing complications.<\/jats:p>","DOI":"10.1055\/a-2517-0803","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T18:58:23Z","timestamp":1737053903000},"page":"787-793","source":"Crossref","is-referenced-by-count":1,"title":["Simultaneous Symmetrizing Surgery on the Contralateral Breast in Unilateral Autologous Breast Reconstruction Is Cost-Effective"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0602-1302","authenticated-orcid":false,"given":"K. Lynn","family":"Zhao","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander J.","family":"Kammien","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Graetz","sequence":"additional","affiliation":[{"name":"Health Outcomes and Research Center, Department of Surgery, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda S.","family":"Moore","sequence":"additional","affiliation":[{"name":"Health Outcomes and Research Center, Department of Surgery, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brogan G.","family":"Evans","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric B.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Health Outcomes and Research Center, Department of Surgery, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5806-378X","authenticated-orcid":false,"given":"Haripriya S.","family":"Ayyala","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/00006534-200009020-00003","article-title":"Determinants of patient satisfaction in postmastectomy breast reconstruction","volume":"106","author":"A K Alderman","year":"2000","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1097\/PRS.0b013e3181cb6351","article-title":"Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques","volume":"125","author":"J H Yueh","year":"2010","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/pon.4586","article-title":"Body image dissatisfaction in patients undergoing breast reconstruction: examining the roles of breast symmetry and appearance investment","volume":"27","author":"I Teo","year":"2018","journal-title":"Psychooncology"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/00006534-200207000-00016","article-title":"Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience","volume":"110","author":"A Losken","year":"2002","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"e4861","DOI":"10.1097\/GOX.0000000000004861","article-title":"Analysis of breast aesthetic revision procedures after unilateral abdominal-based free-flap breast reconstruction: a single-center experience with 1251 patients","volume":"11","author":"J M Smith","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/PPO.0b013e31817fbe2b","article-title":"Managing the opposite breast: contralateral symmetry procedures","volume":"14","author":"M Y Nahabedian","year":"2008","journal-title":"Cancer J"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/SAP.0b013e31824685a9","article-title":"Simultaneous contralateral reduction mammoplasty or mastopexy during unilateral free flap breast reconstruction","volume":"71","author":"E I Chang","year":"2013","journal-title":"Ann Plast Surg"},{"issue":"06","key":"ref8","first-page":"472","article-title":"Benefit of simultaneous contralateral breast symmetry procedure with unilateral breast reconstruction using DIEP flaps. About 33 cases","volume":"60","author":"J Pauchot","year":"2015","journal-title":"Ann Chir Plast Esthet"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/00006534-199308000-00005","article-title":"TRAM flap breast reconstruction and contralateral reduction or mastopexy","volume":"92","author":"T R Stevenson","year":"1993","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1097\/SAP.0b013e31820859c5","article-title":"Simultaneous contralateral breast reduction\/mastopexy with unilateral breast reconstruction using free abdominal flaps","volume":"67","author":"J J Huang","year":"2011","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1055\/s-0032-1311682","article-title":"Simultaneous contralateral breast adjustment in unilateral deep inferior epigastric perforator breast reconstruction","volume":"28","author":"A Inbal","year":"2012","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/SAP.0b013e3181877b26","article-title":"One hundred forty-one consecutive attempts at autologous tissue single-stage breast cancer reconstruction","volume":"63","author":"S Haykal","year":"2009","journal-title":"Ann Plast Surg"},{"issue":"10","key":"ref13","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/j.bjps.2016.06.009","article-title":"Contralateral breast symmetrisation in unilateral DIEP flap breast reconstruction","volume":"69","author":"R G Wade","year":"2016","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1097\/SLA.0000000000001457","article-title":"A longitudinal assessment of outcomes and healthcare resource utilization after immediate breast reconstruction-comparing implant- and autologous-based breast reconstruction","volume":"262","author":"J P Fischer","year":"2015","journal-title":"Ann Surg"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/PRS.0b013e318277856f","article-title":"Comprehensive outcome and cost analysis of free tissue transfer for breast reconstruction: an experience with 1303 flaps","volume":"131","author":"J P Fischer","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s12874-015-0001-6","article-title":"The impact of standardizing the definition of visits on the consistency of multi-database observational health research","volume":"15","author":"E A Voss","year":"2015","journal-title":"BMC Med Res Methodol"},{"issue":"16","key":"ref17","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1056\/NEJMoa020989","article-title":"Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer","volume":"347","author":"U Veronesi","year":"2002","journal-title":"N Engl J Med"},{"issue":"13","key":"ref18","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1056\/NEJM198903303201302","article-title":"Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer","volume":"320","author":"B Fisher","year":"1989","journal-title":"N Engl J Med"},{"issue":"04","key":"ref19","first-page":"CD002748","article-title":"Risk-reducing mastectomy for the prevention of primary breast cancer","volume":"4","author":"N E Carbine","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"ref20","doi-asserted-by":"crossref","first-page":"3100","DOI":"10.1245\/s10434-016-5443-5","article-title":"Contralateral prophylactic mastectomy (CPM) consensus statement from the American Society of Breast Surgeons: data on CPM outcomes and risks","volume":"23","author":"J C Boughey","year":"2016","journal-title":"Ann Surg Oncol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"7S","DOI":"10.1097\/PRS.0000000000003941","article-title":"Current trends in postmastectomy breast reconstruction","volume":"140","author":"H Panchal","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"ref22","doi-asserted-by":"crossref","first-page":"3212","DOI":"10.1245\/s10434-013-3116-1","article-title":"Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database","volume":"20","author":"F Osman","year":"2013","journal-title":"Ann Surg Oncol"},{"issue":"S 01","key":"ref23","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1097\/SAP.0000000000002802","article-title":"Is it worth the risk? contralateral prophylactic mastectomy with immediate bilateral breast reconstruction","volume":"87","author":"T M Chadab","year":"2021","journal-title":"Ann Plast Surg"},{"issue":"13","key":"ref24","doi-asserted-by":"crossref","first-page":"4113","DOI":"10.1245\/s10434-013-3108-1","article-title":"Operative risks associated with contralateral prophylactic mastectomy: a single institution experience","volume":"20","author":"M E Miller","year":"2013","journal-title":"Ann Surg Oncol"},{"issue":"06","key":"ref25","doi-asserted-by":"crossref","first-page":"S153","DOI":"10.1097\/SAP.0000000000000099","article-title":"Predictors of contralateral prophylactic mastectomy and the impact on breast reconstruction","volume":"72","author":"X A Pinell-White","year":"2014","journal-title":"Ann Plast Surg"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1097\/SLA.0000000000001840","article-title":"Tradeoffs associated with contralateral prophylactic mastectomy in women choosing breast reconstruction: results of a prospective multicenter cohort","volume":"266","author":"A O Momoh","year":"2017","journal-title":"Ann Surg"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"373","DOI":"10.7326\/0003-4819-159-6-201309170-00003","article-title":"Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey","volume":"159","author":"S M Rosenberg","year":"2013","journal-title":"Ann Intern Med"},{"issue":"11","key":"ref28","doi-asserted-by":"crossref","first-page":"3474","DOI":"10.1245\/s10434-015-4628-7","article-title":"The effect of contralateral prophylactic mastectomy on perioperative complications in women undergoing immediate breast reconstruction: a NSQIP analysis","volume":"22","author":"A K Silva","year":"2015","journal-title":"Ann Surg Oncol"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/cncr.23214","article-title":"Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer","volume":"112","author":"A K Alderman","year":"2008","journal-title":"Cancer"},{"issue":"16","key":"ref30","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1200\/JCO.2010.29.4041","article-title":"Clinical management factors contribute to the decision for contralateral prophylactic mastectomy","volume":"29","author":"T A King","year":"2011","journal-title":"J Clin Oncol"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1097\/PRS.0000000000001276","article-title":"Bilateral mastectomy versus breast-conserving surgery for early-stage breast cancer: the role of breast reconstruction","volume":"135","author":"C R Albornoz","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref32","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/PRS.0b013e3182729cde","article-title":"A paradigm shift in U.S. breast reconstruction: increasing implant rates","volume":"131","author":"C R Albornoz","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"ref33","first-page":"658","volume-title":"The Surgery of the Breast: Principles and Art","author":"M E Lippman","year":"2006"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1053\/ejso.1999.0733","article-title":"The psychological impact of immediate rather than delayed breast reconstruction","volume":"26","author":"S K Al-Ghazal","year":"2000","journal-title":"Eur J Surg Oncol"},{"issue":"03","key":"ref35","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.breast.2004.10.008","article-title":"Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study","volume":"14","author":"E E Elder","year":"2005","journal-title":"Breast"},{"issue":"06","key":"ref36","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1159\/000485234","article-title":"Psychosocial aspects of immediate versus delayed breast reconstruction","volume":"12","author":"A S Heimes","year":"2017","journal-title":"Breast Care (Basel)"},{"issue":"03","key":"ref37","doi-asserted-by":"crossref","first-page":"302","DOI":"10.5999\/aps.2015.42.3.302","article-title":"Contralateral breast symmetrisation in immediate prosthetic breast reconstruction after unilateral nipple-sparing mastectomy: the tailored reduction\/augmentation mammaplasty","volume":"42","author":"M Salgarello","year":"2015","journal-title":"Arch Plast Surg"},{"issue":"04","key":"ref38","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1097\/PRS.0000000000010713","article-title":"Symmetric breast surgery: balancing procedures versus prophylactic mastectomy and immediate reconstruction","volume":"153","author":"B Bitoiu","year":"2024","journal-title":"Plast Reconstr Surg"},{"issue":"09","key":"ref39","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.ijsu.2013.06.844","article-title":"Plastic surgical management of the contralateral breast in post-mastectomy breast reconstruction","volume":"11","author":"H Rizki","year":"2013","journal-title":"Int J Surg"},{"issue":"06","key":"ref40","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1097\/PRS.0000000000006225","article-title":"Elective revisions after breast reconstruction: results from the mastectomy reconstruction outcomes consortium","volume":"144","author":"J A Nelson","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"ref41","doi-asserted-by":"crossref","first-page":"e242","DOI":"10.1097\/GOX.0000000000000111","article-title":"The number of operations required for completing breast reconstruction","volume":"2","author":"J S Eom","year":"2014","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"01","key":"ref42","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/SAP.0b013e31828bb1e3","article-title":"Choosing the optimal timing for contralateral symmetry procedures after unilateral free flap breast reconstruction","volume":"74","author":"E I Chang","year":"2015","journal-title":"Ann Plast Surg"},{"issue":"02","key":"ref43","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/SAP.0b013e31824b3dcc","article-title":"An assessment of the risks and benefits of immediate autologous breast reconstruction in patients undergoing postmastectomy radiation therapy","volume":"71","author":"M N Mirzabeigi","year":"2013","journal-title":"Ann Plast Surg"},{"issue":"10","key":"ref44","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1002\/bjs.6693","article-title":"Effect of postoperative radiotherapy on autologous deep inferior epigastric perforator flap volume after immediate breast reconstruction","volume":"96","author":"J S Chatterjee","year":"2009","journal-title":"Br J Surg"},{"issue":"06","key":"ref45","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1097\/01.PRS.0000117192.54945.88","article-title":"Delayed-immediate breast reconstruction","volume":"113","author":"S J Kronowitz","year":"2004","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref46","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1097\/PRS.0000000000003168","article-title":"Reconstruction of the irradiated breast: a national claims-based assessment of postoperative morbidity","volume":"139","author":"M D Chetta","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref47","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1002\/jso.27398","article-title":"Plastic surgery market share of breast reconstructive procedures: an analysis of two nationwide databases","volume":"128","author":"D H Rochlin","year":"2023","journal-title":"J Surg Oncol"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2517-0803.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T22:51:41Z","timestamp":1759359101000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2517-0803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":47,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2025,10,1]]},"published-print":{"date-parts":[[2025,11]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2517-0803","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1,16]]},"published":{"date-parts":[[2025,1,16]]}}}