Immediate breast reconstruction following modified radical mastectomy for breast cancer

Abstract

Breast cancer is the most common cancer among women; the life time incidence of breast cancer for American women is 8%. The diagnostic strategies for breast cancer include history, clinical breast examination, breast imaging including: sono-mammography or magnatic resonance imaging (MRI) and tissue diagnosis including; fine needle aspiration cytology (FNAC), core needle biopsy or surgical excisional biopsy. The surgical management of breast cancer involves four major aspects; the breast parenchyma, the skin envelope, the nipple areola complex and axillary lymph node. There has been a trend toward a more conservative approach to the surgical extirpation of breast cancer. There are two approaches to breast cancer extirpation, the first approach is removal of the tumor with 1 to 2 cm margin of the surrounding tissue and the second approach is removal of all breast tissue. The value of the second approach is the preservation of much of patient skin which acts as envelop for immediate breast reconstruction. The technique of skin sparing mastectomy as an oncologically safe one, based on an absence of breast ductal epithelium at the margin of the native skin flaps, so it isn't an option if there is possibility that tumor cells, are close to the skin such as inflammatory breast cancer.

Skin sparing mastectomy isn't usually performed if you have decided that you will not have immediate breast reconstruction. Immediate reconstructive breast procedure includes many techniques which include implant pedicled flap, free flap reconstruction or combined implant and flap reconstruction. Flap reconstruction include latissmus dorsi myocutaneus flap, transversus rectus abdominis myocutaneus transposition flap and micro-vascular composition tissue transplantation. Women who choose immediate reconstruction have to make the decision at a time of great stress; however, for some women, the idea of having the breast tissue reconstructed immediately after mastectomy relieves much of the stress associated with mastectomy. Women who delay reconstruction may go through two periods of emotional readjustment: the first period is adjusting to the loss of a breast and the second readjustment involves accepting the reconstructed breast as their own. The decision-making process for breast reconstruction that alone does not confer survival benefit can be complex and will largely rest on the patient’s personal values and beliefs and guidance from the surgeon. Therefore, competency of a plastic surgeon lies not only in his or her technical skills to carry out the reconstruction but also in his or her knowledge of the advantages and disadvantages of each procedure, the different oncologic aspects, and the long-term objective and subjective implications of surgery.