The authors present a single center's experience in bilateral
breast reconstruction using perforator
free flaps. The aim of this study was to show their indications, surgical technique, and results. A series of 53 patients underwent this procedure between February of 1996 and October of 2002. The
surgical procedures were performed on patients with bilateral
breast cancer (11 patients), patients with
unilateral breast cancer and contralateral
prophylactic mastectomy (22 patients), patients who had undergone bilateral
prophylactic mastectomy (18 patients), a patient with Poland's syndrome, and a patient whose aesthetic breast augmentation had failed. Primary and secondary bilateral
breast reconstructions were done in 18 and four patients, respectively. Eighteen patients who had earlier undergone
breast reconstruction with implants had a tertiary
breast reconstruction. Combined reconstruction (primary with secondary and primary with tertiary reconstruction) was done in 13 patients. Ninety-eight deep inferior epigastric
perforator flaps and eight superior gluteal artery
perforator flaps were used. The average
operative time was 10 hours (range, 8 to 14.5 hours) for the simultaneous bilateral reconstruction. Total flap
necrosis occurred in two cases (one deep inferior epigastric
perforator flap and one superior gluteal artery
perforator flap). Partial flap
necrosis was not encountered, and
fat necrosis was found in one deep inferior epigastric
perforator flap (1 percent). Two pulmonary
infections, one
deep vein thrombosis, and one
cardiac arrhythmia occurred as postoperative complications. The mean
hospital stay was 9 days (range, 6 to 20 days). Abdominal bulging was reported in one patient. There were no recurrent disease or
cancer manifestations, with an average follow-up of 3.5 years. This series clearly shows that
perforator flaps are reliable and useful tools for bilateral
breast reconstruction. This technique decreases the donor-site morbidity and offers an excellent aesthetic and long-term outcome and high patient satisfaction.