BREAST RECONSTRUCTION AFTER SKIN SPARING MASTECTOMY FOR EARLY BREAST CANCER

Abstract

Breast cancer is the most common malignant tumor among women; approximately 12.5% of all women in the industrialized countries will develop breast cancer in their lives. One of the cornerstones of breast cancer treatment is surgery along with radiation therapy and systemic treatment with chemotherapy, endocrine manipulation.

Breast cancer is in fact a heterogeneous disease representing a broad spectrum of biologic potential. Current treatment is highly multidisciplinary, requiring close collaboration between the diagnostic radiologist, oncologic surgeon, medical oncologist, and radiotherapist.

For women facing mastectomy, a good cosmetic outcome is one of the principle goals of Breast Reconstruction (BR) surgery. Measurement of cosmesis is therefore critical, and it is essential that measures are accurate and reliable to make valid comparisons between differenttypes of surgery.

The psychosocial benefits of breast reconstruction in the treatment of breast cancer have been widely accepted with most authors offering women the option of breast reconstruction at the time of mastectomy or as a delayed procedure if immediate reconstruction is contraindicated.

The breast tissue can be replaced with an implant or the breast is created using some of the woman's own tissues (autologous reconstruction) or a combination of the two. There is disagreement in the literature regarding the best method of breast cancer reconstruction and debate on how to assess this.

The most techniques commonly used for autologous breast reconstruction include, Latissimus dorsi myocutaneous (LD) flap, TRAM (Transverse Rectus abdominis Myocutaneous) flaps, deep inferior epigastric perforator (DIEP) flap.

Ideal reconstruction of the nipple areola complex (NAC) requires symmetry in position, size, shape, texture, pigmentation and projection. Reconstruction of the areola has been achieved by grafting, dermabrasion and tattoo. Reconstruction of the nipple has been achieved by grafting, local flaps and internal nipple prostheses.

Plastic surgeons are continuously advancing their search for additional, more dynamic, operative techniques, in spite of the wide variety of options already available.