Synchronus Breast Reconstruction After Surgical Treatment of Breast Cancer

Abstract

Woman's breasts are primary symbol of her femininity and the loss of a breast can be a major impairment to her body image and feeling of attractiveness. This loss can have devastating sequalae causing a marked impact on the women emotional stability and social adjustment, when the lost of the breast is a result of the local treatment of breast cancer. As a result of marvelous development on plastic surgery, reconstruction of breast became easier by different methods and the woman has a role in choosing the suitable procedure with her general surgeon and plastic surgeon all together. This fast development help in technique use in breast reconstruction to face this harvest blow affecting vitality, femininity and configuration of woman. Breast reconstruction operation became a part of management. Immediate breast reconstruction is widely applied nowadays. It improves the psychic and emotional status of the patient, together with improving the cosmetic results of the operation. Also, it is done unless there is unclassical contraindication as improved prognostic mastectomy. Most of early breast reconstruction will need another operation to make the breast same shape and size. Delayed breast reconstruction begins months to years after cancer breast mastectomy. However, oncologically, there is no reason preventing immediate breast reconstruction unless the patient refuses the operation or has a poor prognosis

The procedures used are: 1. Prosthetic breast reconstruction: Balloon expansion, balloon implantation without expansion or using permanent expanders (Becker's prothesis). 2. Autologous breast reconstruction: by flap from the patient body itself including the muscle and skin covering. For example: a) Latissimus Dorsi Flap "L.D.F": Several ways of harvesting this type of flap have been discussed in details. Also a very good aesthetic results and symmetrical distribution can be obtained with L.D.M.F. without the need for implants. Especially with the new modification of the technique of elevation of the muscle and very good amount of subcutaneous fat which gives us more bulk that is quiet sufficient to create breast mound with natural appearing ptosis. b) Rectus Abdominis Flap "R.A.F": It can be harvesting by different means especially, transverse lower methold. The transverse rectus abdominis myocutaneous (TRAM) flap has proven itself over the years as the autogenous tissue of choice for breast reconstruction. Breast reconstruction with the lower abdominal skin and fat provides an abundant source of tissue for the patient who desires a reconstruction without a silicone breast implant and who also wants an abdominoplasty. c) Microvascular free flaps: With the development of microsurgical techniques and in attempt to augment vascular reliability, the TRAM flap was transferred as free flap. Additionally, gluteus maximus