Breast Reconstruction

Breast reconstruction is an integral part of the surgical treatment of breast cancer. Reconstructive options are part of the discussion with a patient if mastectomy is being considered. It is a central component of the discussion if prophylactic mastectomy is being considered.

The options for reconstruction are

1. autologous tissue reconstruction
2. reconstruction with a subpectoral implant or
3. a combination of both.

Reconstruction can be performed immediately or can be delayed until oncologic treatment is complete. Tissue options include using the latissimus dorsi muscle or the transverse rectus abdominus myocutaneous (TRAM) lap, comprising skin, fat and muscle transferred from the abdominal wall.
Tissue flaps can be either pedicled or "free" with a microvascular anastomosis.

Implants are usually placed in a subpectoral position after a pocket has been fashioned and progressively enlarged with a tissue expander. Now most mplants are saline implants, following concerns about the safety of siliconeilled devices. Recently, the moratorium on silicone implants has been lifted, and they are gaining favor, as they have been deemed safe and certainly are capable of achieving a better cosmetic result than saline implants. Subsequent nipple reconstruction can result in an excellent cosmetic outcome.

Immediate reconstruction with tissue generally gives the best cosmetic result and can have psychological benefits.

It is now possible to remove the breast tissue with a very small incision around the nipple (skin-sparing mastectomy), greatly facilitating the quality of the reconstruction by minimizing evident scars. The skin-sparing mastectomy relies on improvements in fiberoptic illumination technology and s gaining popularity. Breast cancer is rarely a disease that involves the skin; therefore, leaving considerable skin behind will have little impact on local control rates.

Patrick I. Borgen and Bruce Mann
Breast conservation therapy for invasive carcinoma of the breast. Current Problems in Surgery 1995; 33:189-256.

{embed="ref/20"}