Simultaneous microsurgery during bilateral autologous breast reconstruction reduces ischemia time without increasing complications

In bilateral deep inferior epigastric perforator (DIEP) flap reconstruction procedures, the microsurgical anastomoses are usually performed consecutively, where one side is completed before the other side is started. However, when a co-surgeon model and loupe magnification are used, it is possible to perform both sides simultaneously. This study assesses the implications of simultaneous versus consecutive microsurgery on ischemia time and postoperative outcomes in bilateral DIEP flap reconstruction.A retrospective chart review was conducted on bilateral DIEP flap breast reconstruction patients between 2017 and 2023. Ischemia time was used to categorize the microsurgical anastomosis, with an overlap of 10 or more minutes between sides classified as "simultaneous microsurgery," and an overlap of less than 10 minutes classified as "consecutive microsurgery." Data were collected on patient demographics, total ischemia time (total time when one or both sides of the abdomen were undergoing microsurgical anastomoses), total operating time, postoperative complications, 90-day postoperative events, hospital length of stay (LOS), and morphine milligram equivalents (MME) required for pain management. Regression analyses assessed the impact of simultaneous versus consecutive microsurgery on key outcomes. Statistical significance was set at <i>p</i> < 0.05.Seventy-four patients met the inclusion criteria for this study. Thirty-one (42%) had undergone simultaneous microsurgery, and 43 (58%) had undergone consecutive microsurgery. There were no significant differences between the two groups in age, body mass index (BMI), race, ethnicity, or baseline comorbidities. Univariate analysis revealed a statistically significant reduction in total ischemia time associated with simultaneous microsurgery (111 minutes vs. 147 minutes; <i>p</i> < 0.001), and no differences in total operating time, complications, 90-day postoperative events, LOS, or MME. These findings were unchanged on multivariate regression controlling for age, BMI, comorbidities, and flap weight.Simultaneous microsurgery during bilateral DIEP flap reconstruction significantly reduces total ischemia time without increasing complications, hospital LOS, or pain management requirements.