D26. Contralateral Breast Symmetrization at Time of Unilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction Reduces Length of Reconstructive Sequence Without Increasing Complications

PURPOSE: Symmetrizing procedures are often performed on the contralateral breast in the setting of unilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction. These procedures can be performed either at the same time as the DIEP flap or later; the clinical implications of the timing, however, remain unclear. This study compared clinical outcomes, complications, and duration of reconstructive sequence between simultaneous and delayed contralateral breast symmetrization in unilateral DIEP reconstruction. METHODS: Retrospective chart review was conducted of patients who underwent DIEP flap breast reconstruction and contralateral symmetrization from 2019-2023. As defined by timing relative to the DIEP flap, patients were separated into two groups: simultaneous symmetrization (SS) and delayed symmetrization (DS). Demographic data, length of index operation, revision procedures, length of stay (LOS), complications, readmissions, and duration of reconstructive sequence were compared using logistical regression analyses (statistical significance set at p<0.05). RESULTS: 127 patients met inclusion criteria, with 30% SS (n=39) and 70% DS (n=88). SS had longer index operation (423 vs. 366 minutes, p=0.008), though were less likely to undergo a revision procedure (46% vs 98%, p<0.001). There was no difference in LOS (p=0.821), complications (p=0.466), or readmissions (p=1.00). Duration of reconstructive sequence was significantly shorter in SS than in DS (152 ±238 days vs. 446 ±377 days, p<0.001). CONCLUSION: When performed at the same time as DIEP flap breast reconstruction, contralateral symmetrization had an equivalent complication rate and inpatient LOS, lower revision rate, and shorter duration of reconstructive sequence compared to symmetrization procedures performed after the index procedure.