Breast reconstruction.

Abstract

Breast reconstruction after mastectomy for breast cancer has usually been performed as a delayed procedure, often not less than one year after completion of postoperative radiation therapy and cytotoxic chemotherapy. The reason for delaying the procedure has been the increased risk of wound complications after the adjuvant therapy. The reconstruction has been even further delayed for patients with increased risk of recurrence in order to avoid a reconstruction 'in vain' for a patient, who will succumb to the disease within a couple of years after the reconstruction. The breast reconstruction can also be performed immediately in conjunction with the mastectomy. The rather slow acceptance of this procedure has mainly been for practical reasons. The mastectomies are usually performed by general surgeons. The operation has not been centralized to larger hospitals, and the patients usually want to have the operation performed as soon as possible. It is therefore often difficult to arrange a joint operation by the general and the plastic surgeons. In addition, suspicions have been raised that enlargement of the dissection area could spread cancer and increase the risk of local metastases. The same types of operation can be used for delayed and immediate breast reconstruction. There are basically two possible ways of creating a new breast mound. One entails transferring muscle, subcutaneous fat and skin into the area of reconstruction in sufficient quantity to shape a breast mound. The other possibility is to shape the breast mound mainly by inserting a prosthesis, similar in consistency to breast tissue into the area of reconstruction. For practical reasons the implant has to be covered by a sufficient amount of soft tissue, and for this purpose a number of pedicled flaps can be used. The implant most commonly used is made of silicone gel and covered by a membrane to prevent the gel from oozing into the surrounding tissues. A recent innovation is an implant with textured surface in order to diminish capsule formation around the prosthesis.