BREAST Simultaneous Endoscope-Assisted Contralateral Breast Augmentation with Implants in Patients Undergoing Postmastectomy Breast Reconstruction with Abdominal Flaps Betul Gozel Ulusal, M.D. Ming-Huei Cheng, M.D., M.H.A. Fu Chan Wei, M.D. Taipei, Taiwan Background: Unilateral breast reconstruction after mastectomy provides the challenge of achieving symmetry with the opposite side. Reduction mas- topexy is a common balancing procedure for the contralateral breast used to achieve pleasing and symmetrical breasts. Although symmetry is the ul- timate goal, some women have a hypoplastic and/or ptotic contralateral breast, and the recreation of this shape would therefore not be desirable. Methods: From April of 2000 to April of 2005, a total of 158 patients un- derwent postmastectomy breast reconstruction using either free deep infe- rior epigastric perforator flaps (n = 142) or superficial inferior epigastric artery flaps (n = 16) at Chang Gung Memorial Hospital. Of the 158 patients, 19 (12.0 percent) underwent endoscope-assisted placement of implants into the contralateral breast at the same surgical stage to form a more pleasing breast mound. Mean patient age was 46.1  7.6 years. All patients had a slender body habitus, with small to medium-sized breasts. Saline-filled im- plants were placed in a submuscular position with the assistance of endos- copy. Five different incisions for access were used: transaxillary (n = 6), Port-A-Cath catheter scar (n = 4), inframammary (n = 1), biopsy scar (n = 1), and transmidline (n = 7). Results: The success rate was 100 percent, with complete survival of the 19 flaps. In three patients, revision procedures were carried out at 12 to 44 months’ follow-up because of implant leakage, capsular contracture, and nipple ptosis (one patient each). The remaining patients were highly satis- fied with the cosmetic result, and symmetry was achieved, with soft, natural appearing breasts during the follow-up period of 29.2  16.9 months. The transmidline approach was superior to the other routes, because no addi- tional scar was produced and access was easier. Conclusions: Contralateral breast augmentation at the same stage with deep inferior epigastric perforator or superficial inferior epigastric artery flap surgery can be performed with high success rates and poses no surgical risks or morbidity to patients. The combined procedure does not significantly extend the time of operation, and aesthetically pleasing results and symmetry can be achieved and sustained over the long term. (Plast. Reconstr. Surg. 118: 1293, 2006.) P atient satisfaction with reconstructive surgery is an important component of multidisci- plinary treatment for breast cancer. Several studies have shown significantly higher patient sat- isfaction with autologous reconstruction. 1– 6 In re- cent decades, the deep inferior epigastric perfora- tor (DIEP) and superficial inferior epigastric artery (SIEA) flaps have arisen as highly refined proce- dures, with reduced donor-site morbidity and su- perior aesthetic satisfaction. 1,5–9 The ultimate goal in unilateral postmastec- tomy breast reconstruction is to create a natural appearing breast while adjusting both the size and shape of the opposite breast in an attempt to create maximum symmetry. 10,11 Using other From the Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University. Received for publication April 27, 2005; accepted August 24, 2005. Copyright ©2006 by the American Society of Plastic Surgeons DOI: 10.1097/01.prs.0000239460.94909.4d www.PRSJournal.com 1293