Simultaneous Bilateral Microsurgery in Autologous Tissue Breast Reconstruction

Summary: Bilateral autologous breast reconstruction requires microsurgery on both sides, increasing operative time and surgeon workload compared with unilateral reconstruction. This study examines the efficacy of a simultaneous microsurgical approach for bilateral breast reconstruction in reducing operative time and burden. A total of 22 patients who underwent bilateral breast reconstruction with deep inferior epigastric artery perforator flaps at the University of Toyama Hospital from March 2020 to December 2023 were included. These comprised 2 groups of patients who underwent either conventional sequential reconstruction or simultaneous reconstruction. In the conventional group, 1 flap was transected, and vascular anastomosis was completed before proceeding to the second flap. Abdominal closure was started after the transection of the second flap. In the simultaneous group, both flaps were transected at approximately the same time, and 2 surgeons performed the microsurgery simultaneously using separate microscopes. Abdominal closure began after both flaps were transected. Our results showed significantly shorter operative time (538 versus 657 min, P = 0.04) and ischemia time (92 versus 177 min, P = 0.006) in the simultaneous group than the conventional group, respectively. No postoperative complications requiring reoperation occurred in the simultaneous group. In the conventional group, there was 1 case of flap loss due to postoperative infection. This study demonstrates that the bilateral simultaneous approach reduced operative and ischemia times while maintaining safety. Despite requiring 2 skilled microsurgeons, this approach offered an efficient and reliable solution for bilateral reconstruction.