Comparative Analysis of Bilateral Stacked Flap and Hybrid Breast Reconstruction: Clinical Results and Patient-reported Outcomes

Background: In autologous breast reconstruction, there may be a disparity between the volume necessary to achieve the ideal reconstruction and the volume of tissue available from a single flap donor site. In such cases, stacked flap reconstruction or hybrid breast reconstruction may provide patients with their desired breast size and shape. Methods: This retrospective cohort study included 119 patients (69 bilateral stacked flap reconstructions, 50 bilateral hybrid reconstructions) who underwent breast reconstruction between 2016 and 2024. Patient demographics, oncological treatment, and operative details were compared. Primary outcomes included postoperative complications and patient-reported outcomes (BREAST-Q). Results: There were no significant differences in patient comorbidities or oncological treatment plans. The hybrid reconstruction group had a shorter duration for the flap procedure (532.6 versus 637 min, P < 0.001), shorter length of stay (4.1 versus 5.1 d, P = 0.003), less frequent use of a cosurgeon (48% versus 95.6%, P < 0.001), and a higher number of total revision procedures ( P = 0.004). There were no significant differences in breast, donor site, or medical complications aside from a higher risk of postoperative breast infection in the hybrid reconstruction group ( P = 0.011). BREAST-Q demonstrated no significant differences in patient-reported outcomes. Conclusions: Stacked flap and hybrid breast reconstructions are both safe and reliable techniques in appropriately selected patients when a single flap donor site lacks sufficient volume to achieve the desired result. There are nuanced differences in the reconstructive processes and surgical outcomes that necessitate thorough patient education and patient selection.