Immediate Versus Delayed Breast Reconstruction after Mastectomy

Abstract

Breast cancer is currently the top cancer in women worldwide. Techniques that are used in treatment of this disease have evolved through the years to eradicate the tumor cells completely while restoring the patient pre-disease state. Breast conservation therapy preservesthe breast and often reduces the demand for reconstruction of post mastectomy defects. Some women undergo partial mastectomy with radiation and maintain excellent breast symmetry and contouring. Others show more noticeable deformities that might require secondary revision or completion mastectomy with reconstruction. Breast reconstruction is a vital component in the management of patients of breast cancer after mastectomy. Reconstruction lessens the psychological and physical burden of the diagnosis. A spectrum of techniques is available from which the patient and surgeon can choose. These techniques can involve non autologus (breast implants),autologous tissue, or both. Breast reconstruction using an autologous tissue includes: 1) Reconstruction with latissimus dorsi muscle flap (LDMF). 2) Reconstruction with rectus abdominis muscle flap. A) Pedicled Flaps: I. Vertical rectus abdominis myocutaneous flap II. Lower transverse rectus abdominis myocutaneous flap. III. Upper transverse rectus abdominis myocutaneous flap.

B) Double pedicle TRAM flap C) Free microvascular TRAM flaps. I. Free TRAM flap. II. Bilateral free TRAM flap reconstruction III. Deep Inferior Epigastric Artery Perforator Flap (DIEP): D) Combination of pedicled and Microvascular TRAM flaps: I. Extended TRAM flap, II. Supercharged TRAM flap. III. Turbocharged TRAM flaps. E) Breast reconstruction by other microvascular free flaps. Complications of autologous breast reconstruction includes: seroma formation, nerve Injury, problems of the flap viability (due to inadequate venous drainage with excessive hyperemia and very rapid blanching and refill), fat necrosis and fibrosis, skin island loss,hypertrophic scar and failure of vascular of anastomosis (in free flaps vascular anastmosis). Complications of prosthetic breast reconstruction includes:muscular tears,deficient skin flaps to close the wound,hematoma formation,infection,wound breakdown, implant malposition,postoperative pain, rupture of implant, Mondor's disease(thrombophlebitis of some part of the superficial mammary venous plexus may result in a tender cord-like lesion) andcapsular contracture.