Timing matters: A comparative analysis of synchronous and metachronous mammoplasty techniques

Background

Therapeutic mammoplasty (TM) is a Level 2 oncoplastic procedure that improves cosmetic outcome in patients undergoing breast conserving surgery (BCS) for breast cancer. The contralateral reduction may be performed at the same time as the index procedure (synchronous) or later (metachronous); commonly cited reasons for the latter include fewer complications, reduced need for revisional surgery and less delay to adjuvant therapies. This study aims to compare synchronous and metachronous approaches to therapeutic mammoplasty.

Materials and methods

A database between 2010 and 2019 was hand searched. The primary outcome measure was the trend of synchronous vs unilateral operating by year. Secondary outcome measures included demographic variables, type of mammoplasty, tumour biology, revisional surgery rate, type and timing of planned revisional surgery, complications, type and time to adjuvant therapy, type of axillary surgery, and tumour trends by year.

Results

155 patients had synchronous mammoplasties and 107 patients had unilateral procedures, of which 26 had delayed contralateral symmetrising surgery. There was a significant increase in the total number of TMs (p < 0.03) and synchronous TMs (p < 0.02) over time. There were no differences in time to chemotherapy (p > 0.05), time to radiotherapy (p > 0.05) or time till re-excision of margins/revision mastectomies (p > 0.05). In the unilateral group, mean time to contralateral symmetrising surgery was 14 months.

Conclusions

Synchronous TMs are increasingly popular and appear safe for patients undergoing BCS for breast cancer. Further work is necessary to establish patient preferences between the two groups.