I.S. Fentiman; H. Hamed

Disclosures

Int J Clin Pract. 2006;60(4):471-474. 

In This Article

Summary and Introduction

The majority of women who are undergoing mastectomy can also have breast reconstruction. In most breast units, implants and latissimus dorsi flaps can be performed. The more sophisticated transverse rectus abdominis myocutaneous (TRAM) flap-based reconstructions are generally performed by plastic surgeons so that there may be logistic problems in using these techniques for immediate reconstruction. Decisions on technique will also depend on the patient's build and co-existing medical conditions together with the likelihood of need for postoperative radiotherapy as part of the primary local treatment.

One of the major advances in the treatment of breast cancer has been the confirmation that breast-conserving surgery is a safe alternative to mastectomy for selected breast cancer patients. Despite this, many women still need mastectomy for optimal local control. These cases include women with large primary tumours suitable for neoadjuvant treatment when the patient does not want primary systemic therapy or when this has failed to achieve sufficient tumour shrinkage. Additionally, there are cases with multicentric or diffuse disease, either invasive or ductal carcinoma in situ (DCIS). Some women will choose mastectomy rather than breast-conserving treatment (BCT), and others will need salvage mastectomy following relapse after BCT. Unless the patient has serious co-morbidity, breast reconstruction should be considered at the time of primary surgery.

Before undergoing breast reconstruction, it is important that the patient has a realistic expectation of outcome. She needs to be aware that the reconstructed breast will neither feel nor function like a normal breast but may help in restoring body image and confidence. Photographs need to be available so that the patient can see good, average and poor cosmetic outcomes. The aim of the surgery is to achieve complete clearance of the invasive and non-invasive breast cancer and not to put this at risk by techniques such as nipple preservation that will lead to an increased rate of local relapse.

Ideally, the reconstructed breast should match with the normal side both in volume and appearance. This may involve procedures such as mastopexy or reduction of the normal side. Some but not all patients will also want nipple reconstruction, and this can be performed with a variety of techniques. Although immediate reconstruction has to be available, patients should not feel pressurised to make a decision and can be reassured that they will not lose their place in the queue if they opt for a delayed procedure.

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