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Breast cancer, as the most frequently diagnosed malignancy in women, remains a worldwide public health dilemma. With the improvement of patients’ quality of life and survival rate, the increasing number of patients tend to choose immediate breast reconstruction (IBR) after mastectomy for breast cancer, which is conducive to improving patients' mental health and life qualities. It has also accelerated the continuous innovation of breast reconstruction technology. However, there are still many controversies globally regarding the choice of postmastectomy reconstruction for different stages of breast cancer. Different stages of breast cancer have big variability in tumor volume, treatment plans, risk of complications, patient demands and cognitive condition. Therefore, multiple aspects such as oncology safety and aesthetic requirements of patients should be taken into consideration by surgeons. Based on clinical experience of Cancer Hospital Chinese Academy of Medical Sciences and domestic and foreign literature, this article aims to analyze the characteristics of immediate breast reconstruction, explores the role of IBR in different stages of breast cancer treatment, and to provide a reference for the comprehensive treatment of breast cancer.
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At present, the most commonly used treatment methods for breast cancer are modified radical mastectomy (MRM) and breast conserving surgery. Patients undergoing breast conserving surgery can achieve good postoperative appearance and efficacy, while its surgical indications are very strict. Most women suffering from breast cancer cannot avoid the physical and mental trauma caused by the loss of breast after MRM. The promotion of immediate breast reconstruction (IBR) has greatly improved the quality of life of patients after surgery. This paper reviews the progress of indications, influencing factors, various surgical methods of IBR after MRM.
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Background: There is a growing demand for breast reconstruction and among the plethora of breast reconstruction techniques, the latissimus dorsi (LD) flap is a versatile, reliable means for soft tissue coverage, providing form and function with acceptable perioperative and long-term morbidities for a variety of breast defects. The aim of this study was to find out the advantages of immediate breast reconstruction in terms of postoperative morbidity and patient satisfaction with respect to her expectations.Methods: The study was conducted in the Department of General Surgery at Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar. Thirty female patients who had undergone immediate breast reconstruction with latissimus dorsi flap after modified radical mastectomy attending surgery department from November 2017 to September 2019 were taken. The follow up was done to find out post-operative complications and a statistical scoring was done according to rating scale of quality of life.Results: Most common complication after breast reconstruction with LD flap was found to be seroma formation (50%) followed by wound infection and flap necrosis 25% each while flap necrosis >20% was not found in any case. For emotional feeling regarding health, social activities, overall health and quality of life; there was significant improvement after surgery.Conclusions: It can be concluded that immediate breast reconstruction with autologous latissimus dorsi flap is the treatment of choice following mastectomy in cases of breast carcinoma, whenever possible.
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RESUMEN Introducción: La reconstrucción mamaria postmastectomía es la forma habitual en nuestro país. En el Instituto de Oncología se realizan en la actualidad con sistematicidad de manera inmediata para disminuir el impacto psicológico de la mastectomía. Objetivo: Evaluar el comportamiento de la reconstrucción mamaria inmediata con el uso de expansores tisulares. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo y longitudinal, en pacientes ingresadas en el Instituto Nacional de Oncología y Radiología con criterios de reconstrucción mamaria inmediata con expansores tisulares, en el periodo comprendido entre octubre de 2015 a diciembre de 2018. El universo estuvo conformado por 51 paciente siendo la muestra 43. Resultados: Predominó la reconstrucción en mujeres entre 40 y 49 de color de la piel blanca. La mayoría con hábitos tóxicos de fumadoras. Se realizó como técnica quirúrgica la reconstrucción inmediata con expansión tisular, fue el más utilizado el anatómico. Las principales complicaciones estuvieron relacionadas con la radioterapia y hábitos tóxicos. Conclusiones: Todas las mujeres se reconstruyeron con expansor tisular, de forma inmediata, con bajo índice de complicaciones(AU)
ABSTRACT Introduction: Postmastectomy breast reconstruction is the usual way in our country. At the Oncology Institute they are currently performed systematically immediately to lessen the psychological impact of mastectomy. Objective: To evaluate the behavior of immediate breast reconstruction with the use of tissue expanders. Methods: An observational, descriptive, retrospective and longitudinal study was carried out in patients admitted to the National Institute of Oncology and Radiology with criteria for immediate breast reconstruction with tissue expanders, in the period from October 2015 to December 2018. The universe it was made up of 51 patients, sample 43. Results: Reconstruction predominated in women between 40 and 49 of white skin color. Most with toxic smoking habits. Immediate reconstruction with tissue expansion was performed as a surgical technique, anatomical was the most used. The main complications were related to radiation therapy and toxic habits. Conclusions: All the women were reconstructed with a tissue expander, immediately, with a low rate of complications(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Breast Neoplasms/epidemiology , Tissue Expansion Devices/adverse effects , Mammaplasty/methods , Mastectomy/methods , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies , Observational Studies as TopicABSTRACT
Immediate breast reconstruction can reduce the psychological trauma of breast loss while preventing patients from undergoing secondary surgery.However,oncologists must ensure tumor safety when choosing immediate breast reconstruction.Careful preoperative evaluation and adequate intraoperative glandectomy are the prerequisites to ensure oncologic safety.The National Comprehensive Cancer Network(NCCN) guidelines clearly states that inflammatory breast cancer is a contraindication to immediate breast reconstruction.In addition,for patients who plan to receive postoperative radiotherapy,immediate breast reconstruction should be carefully selected.Despite the lack of high-level evidence-based evidence,available data show that immediate breast reconstruction does not affect postoperative adjuvant chemotherapy.It is safe and reliable for some patients to choose the subcutaneous gland resection that retains nipples and areola.Lymphoma after prosthesis implantation has been reported,but the incidence is low.Therefore,breast reconstruction immediately after mastectomy is a safe and reliable surgical procedure in suitable patients with breast cancer.
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Mastectomy is still the main surgery method to treat breast cancer in China.Breast surgeons should be more devoted to breast reconstruction.Although different reconstruction methods should comprehensively consider the patient's wishes and the doctor's technical ability and other factors,it is necessary for breast surgeons to adhere to the principle of tumor safety,reasonably design the incision of breast surgery,master the technology of preserving the nipple areola complex,and separate the thickness and scope of the flap.Under the mode of multidisciplinary cooperation,breast surgeons should actively participate in the training,keep learning and practicing,make effort to improve the overall treatment level of breast cancer patients and promote the standardized process of breast reconstruction after breast cancer surgery in China.
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Combined with the concept and technique of plastic surgery,breast reconstruction has become an important development direction in the field of breast surgery on the premise of ensuring tumor safety.Breast reconstruction can be performed at the same time as mastectomy or partial mastectomy,or it can be delayed until the appropriate time after the completion of adjuvant therapy.The former is called immediate breast reconstruction,and the latter is called delayed breast reconstruction.Clinically,the timing of reconstruction is determined by the stage of disease and the patients ' needs.Delayed-immediate breast reconstruction was used in some patients to reduce the adverse effects of adjuvant radiotherapy and the occurrence of serious postoperative complications.Breast reconstruction also includes autologous flap breast reconstruction,implant-based breast reconstruction and autologous combined implant breast reconstruction.Implant based reconstruction is the most commonly used technique in immediate breast reconstruction.For delayed breast reconstruction,autologous flapbased breast reconstruction or two-step implant-based reconstruction is more frequently.
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Objective To investigate the clinical efficacy and cosmetic outcome of two methods of immediate breast reconstruction and modified radical mastectomy for the patients with breast cancer after breast cancer surgery. Methods The clinical data of 95 patients with early breast cancer in the First Affiliated Hospital of Jinzhou Medical University from October 2014 to September 2018 were retrospectively analyzed. The patients were divided into latissimus dorsi combined with implants group (27 cases), titanium-coated polypropylene mesh combined with implants group (18 cases) and modified radical group (50 cases). The differences of surgical data, postoperative complications and quality of life were compared in the three groups. The postoperative cosmetic effect of two immediate reconstruction groups was observed. Results The differences of drainage duration and intraoperative blood loss in the three groups were not statistically significant (both P > 0.05). There were statistical differences in the hospital stay and the postoperative quality of life score (both P < 0.01). The incidence of postoperative complications in latissimus dorsi combined with implants group, the titanium-coated polypropylene mesh combined with implants group and the modified radical group was 48.1％ (13/27), 22.2％ (4/18) and 12.0％ (6/50), respectively. And the difference between latissimus dorsi combined with implants group and the modified radical surgery group was statistically significant (χ 2 = 12.33, P < 0.01). The good rate of cosmetic effect in titanium-coated polypropylene mesh group was higher than that in latissimus dorsi combined with implants group, and there was no statistically significant difference [83.3％ (15/18) vs. 81.5％ (22/27), χ 2 = 0.025, P > 0.05]. Conclusions Immediate breast reconstruction including latissimus dorsi combined with implants or titanium-coated polypropylene mesh combined with implants after radical mastectomy on the basis of indications can improve the quality of life and the cosmetic results of patients, but postoperative treatment is necessary for the increased complications after the two reconstruction methods.
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Objective@#To explore the oncological safety of immediate breast reconstruction after nipple-areola complex(NAC) sparing mastectomy(NSM+ IBR) in patients with early stage breast cancer, and to analyze the prognostic factors of NSM+ IBR.@*Methods@#From January 2004 to December 2015, the clinical data of 118 cases of stage Ⅰ-ⅡA breast cancer who had undergone NSM+ IBR in Tianjin Tumor Hospital were collected, comparing with 75 cases of Ⅰ-ⅡA breast cancer patients who had undergone immediate breast reconstruction after modified radical mastectomy (MRM+ IBR) at the same period. In addition to the prognosis of these two groups, the prognostic factors were also retrospectively analyzed.@*Results@#The median follow-up were 53 months in the NSM+ IBR group and 51 months in the MRM+ IBR group, respectively. In the NSM+ IBR group, local recurrence, distant metastasis, death and NAC necrosis occurred in 4, 6, 9 and 4 cases during 3 years after operation, respectively. The local recurrence rate (LRR) was 3.4%, 3-year disease-free survival (DFS) rate was 91.5%, and the overall survival (OS) rate was 92.4%. In the MRM+ IBR group, local recurrence, distant metastasis, and death occurred in 1, 4, and 3 cases during 3 years after operation, respectively. The LRR was 1.3%, 3-year DFS was 93.3%, whereas the OS rate was 96.0%. No statistical difference was noted between the two groups (all P>0.05). That HER-2 positive and molecular type correlated with the 3-year DFS (P<0.05) independently and molecular type correlated with OS (P<0.05) independently in the NSM+ IBR group.@*Conclusions@#NSM does not impair patients′ prognosis and could ensure oncological safety of patients with early stage breast cancer. IBR could improve female patients′ figure and ensure the quality of life. HER-2 status and molecular type are the independent prognostic factors of the 3-year DFS. Molecular type is the independent prognosis factor of OS.
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Objective@#To discuss the surgical treatment and efficacy of endoscopic nipple-sparing mastectomy with skin lifting system (ENSMSLS) followed by immediate breast reconstruction.@*Methods@#ENSMSLS was conducted on 21 patients followed by immediate breast reconstruction with implant via axillary incision from August 2014 to January 2016 in Oncology Center, Beijing Tongren Hospital, Capital Medical University. These 21 patients were frequency matched with 21 patients, who received nipple-sparing mastectomy via loop periareolar incision from November 2012 to May 2015 in the same center. These 21 patients formed the control group. The operation data of two groups were compared by t test and Fisher′s exact test.@*Results@#Differences in operation time ((185±43) minutes vs. (165±33) minutes, t=1.778, P=0.101), amount of bleeding ((60±48) ml vs. (75±57) ml, t=-0.535, P=0.329), and drainage ((240±112) ml vs. (201±91) ml, t=1.238, P=0.233) between these two groups of patients were not statistically significant. There was no nipple necrosis recorded in the ENSMSLS group, while there were three cases (14.3%) recorded in the control group. Two cases (9.5%) of nipple transposition were recorded in the ENSMSLS group, while five cases (23.8%) were recorded in the control group. Differences in nipple necrosis and nipple transposition were statistically significant (0 vs. 5, P=0.001). There were 16 cases (76.2%) of excellent appearance recorded in the ENSMSLS group, while there were 11 cases (52.4%) recorded in the control group. There were 5 cases (23.8%) of good appearance recorded in the ENSMSLS group, while there were 9 cases (42.9%) recorded in the control group. There was no case of fair appearance in the ENSMSLS group, while there was 1 case (4.8%) recorded in the control group. Difference in postoperative appearance was statistically significant (P=0.001).@*Conclusions@#ENSMSLS significantly decreases the possibility of nipple necrosis and nipple transposition. This technique avoids visible incisions of breast. It also enhances the aesthetic appeal of reconstructed breasts.
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Objective@#To explore the impact of immediate breast reconstruction on the onset of adjuvant chemotherapy and on the postoperative complications.@*Methods@#We retrospectively analyzed the clinical data from female breast cancer patients treated by either modified radical mastectomy with immediate breast reconstruction(IBR) ( n=108) or modified radical mastectomy alone(n=115), followed by adjuvant chemotherapy at our department between January 2011 and December 2012.@*Results@#There was no significant difference in the overall complication rates between the IBR group and modified radical mastectomy group (49.1% vs. 52.2%, P=0.87). However, more secondary surgery was applied in the IBR group than the modified radical mastectomy group (13.0% vs. 1.7%, P=0.001). However, the incidence of hematoma in the modified radical mastectomy group was significantly higher than the IBR group (17.4% vs. 4.6%, P=0.003). There was a significant difference in the onset of adjuvant chemotherapy between the IBR group and modified radical mastectomy group (21 days vs. 11days, P<0.001).@*Conclusions@#Immediate breast reconstruction has no significant impact on the overall complication rate, but increases the incidence of secondary surgery, especially after the initiation of chemotherapy. In addition, it slightly delays adjuvant chemotherapy in the patients.
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Objective:To compare the therapeutic effects between immediate breast reconstruction (IBR) after skin-sparing mastecto-my and modified radical mastectomy (MRM) in young breast cancer patients (≤35 years), as well as to analyze the prognostic factors of IBR in these patients. Methods:The clinicopathological data of young breast cancer patients who had undergone IBR after skin-spar-ing mastectomy (60 cases) and MRM (68 cases) in Liuzhou People's Hospital from July 2008 to June 2014 were retrospectively ana-lyzed. Local recurrence, disease-free survival, and overall survival of the patients between the two groups were compared. The influ-encing factors for survival of the IBR group patients, such as age, tumor size, and nipple-areolar complex preservation, were analyzed. Results:All patients were followed-up for a period ranging from 15 to 88 months with a median of 51. In the IBR group, local recur-rence, distant metastasis, and death occurred in 3, 8, and 5 cases, respectively. The 3-and 5-year disease-free survival rates (DFSR) were 91.7%and 81.7%, respectively, whereas the overall survival rate (OSR) was 91.7%. In the MRM group, local recurrence, distant metastasis, and death occurred in 2, 9, and 5 cases, respectively. The 3-and 5-year DFSRs were 94.1%and 83.8%, respectively, where-as the OSR was 92.6%. No statistical difference was noted between the two groups (P>0.05). The analysis of prognostic correlation fac-tors in the IBR group patients shows that lymph node metastasis and estrogen and progesterone receptor-negative correlated with the tumor-free survival and overall survival rates (P<0.05). Conclusion:No apparent statistical difference in the comparison of the local re-currence and long-term survival rate was observed between the two groups' young breast cancer patients who underwent IBR after skin-sparing mastectomy and MRM. IBR after skin-sparing mastectomy is safe for young breast cancer patients with early-stage, and nipple-areolar complex preservation does not increase the risk of recurrence in the IBR group patients. Lymph node metastasis and es-trogen and progesterone receptor-negative are the major prognostic factors of IBR after skin-sparing mastectomy in young breast can-cer patients.
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BACKGROUND: Breast reconstruction (BR) plays a significant role in the woman’s physical, emotional and psychological recovery from breast cancer. However, the current most accepted methods of reconstruction are expensive, may require microsurgical skills and can be offered to a very small number of patients seeking treatment in tertiary care centers. For the large majority of women seeking treatment in public hospitals, solution lies in finding a method of reconstruction, which is autologous, produces a reasonable match to the contralateral breast in size, shape and symmetry and produces minimal donor site morbidity. It should also be a technique, which is cost effective and can withstand the effects of radiotherapy (RT). The autologous latissimus dorsi (LD) flap is one such versatile technique, which can serve as an ideal reconstructive option for the majority of patients. MATERIALS AND METHODS: During a period of 6 years, 19 patients underwent immediate BR using this flap in the Department of General Surgery. Patients who were young (mean age 37.4 years), had small to medium sized breasts, with operable breast cancer (Stage II and IIIa) were selected for the procedure. RESULTS: Satisfactory cosmetic results as rated by patients as well as surgeons were achieved in the majority. Donor site morbidities were seroma formation (78%) and donor site wound breakdown (21%). Post‑operative RT was well‑tolerated by the reconstructed breast. CONCLUSION: Autologous LD flap reconstruction is a safe and economical option for BR in low resource settings and is suitable for women with small and medium sized breasts.
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Objective:To compare the therapeutic effect of immediate breast reconstruction using latissimus dorsi musculocutane-ous flap after modified radical mastectomy with the conventional modified radical surgery of breast cancer. Methods:A retrospec-tive analysis of 224 female patients with Stage 0 to IIIA breast cancer was conducted. The patients were admitted to the Department of Breast Surgery of Liuzhou People's Hospital between November 2009 and July 2012. The cases were divided into two groups accord-ing to different surgical options:immediate breast reconstruction (IBR) and modified radical surgery of the breast (MRSB). After con-trastive analyses of the postoperative complications, cosmetic results, quality of life, local failure rate, distant metastases and mortality rates between the two groups, the therapeutic efficiency of the two surgeries was evaluated. Results:No statistical differences were ob-served in the postoperative complications between the two groups, such as hydrops, skin flap necrosis, limb exercise and shoulder joint motion, drainage time, and starting time of adjuvant therapy (P>0.05). The patients in the IBR group had a better quality of life than those in the MRSB group (P0.05). Conclusion:Compared with the tradi-tional MRSB group, the option of IBR after modified radical mastectomy not only achieves similar therapeutic outcomes but also pres-ents advantages such as better aesthetic effect of the reconstructed breast, easy surgical procedures, high safety, improvement of the breast contour outline, and improved quality of life after operation. Therefore, IBR is a safe and available therapeutic method for pa-tients with early breast cancer.
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Objective:To demonstrate the selection of breast implant during an immediate breast reconstruction post-mastectomy and analyze the indication of this technique. Methods:From June 2007 to June 2012, a total of 121 patients with breast cancer received immediate breast reconstruction with breast implants. Among the 121 patients, 89 patients had simple mastectomy, while the rest under-went modified radical mastectomy in the Department of Breast Neoplasm, Nanchang No.3 Hospital. The volumes of the resected breast tissues were measured using Archimedes principle. The diameters of the tissues were also determined. Proper breast implants were se-lected according to the measured data. Results: Postoperative complications, such as implant exposure, flap necrosis, and infection, were not found. Follow-up period ranged from 6 months to 12 months. Patients answered a questionnaire that displayed their degree of satisfaction for the breast operation outcome. Results show that 89.3%of the patients (108/121) were very satisfied, 9%were (11/121) satisfied, and 1.7%(2/121) were unsatisfied. Conclusion:Immediate breast reconstruction with breast implant post-mastectomy is an ideal method for rebuilding the breast. This technique is advantageous because it prevents damage to the donor site and retains the maxi-mal elasticity of the skin for breast reconstruction. Accurate parameters of breast implants, which are important to achieve good surgical results, could be obtained using Archimedes principle.
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Objective:This study was conducted to evaluate whether or not immediate breast reconstruction influences quality of life and patient body image satisfaction outcomes among Chinese women with breast cancer compared with modified radical mastecto-my. Methods:Sixty patients with breast cancer and were operated from July 2011 to July 2012 in Cancer Institute&Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were included. These patients were divided into two groups:Ⅰ(30 patients) underwent modified radical mastectomy andⅡ(30 patients) underwent mastectomy with immediate breast reconstruction. Pa-tient satisfaction with breast reconstruction was evaluated by functionally assessing cancer therapy-breast cancer scale (FACT-B) and the scales that we designed. Results:No significant differences were observed between the two groups in terms of baseline characteris-tics, histopathological characteristics, and incision conditions (P>0.05). The patients in groupⅡ(immediate breast reconstruction) ex-hibited improved body image satisfaction outcomes (41.1 ± 10.8 vs. 33.2 ± 8.8, P=0.003);this difference was still observed after adjust-ment for confounding factors was performed by multiple linear regression. No significant difference was found between the two groups in terms of total FACT-B score and psychological evaluation score (P>0.05). Conclusion:Chinese women who prefer immediate breast reconstruction exhibited an improved body image satisfaction.
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Background and purpose:This study aimed to explore the inlfuences on quality of life of patients with breast cancer in different stages undergone different styles of operations. Methods:During Apr. 2012 and Apr. 2013, a total number of 207 patients with breast cancer, including 61 patients undergone breast conserving surgery (BCS), 60 patients undergone immediate breast reconstruction (IBR) and 86 patients undergone modiifed radical mastectomy (MRM) reviewed or admitted in Beijing Tongren Hospital Afifliated to Capital Medical University were included in the research, in which FACT-B, SAS and SDS were used to assess the quality of life and negative emotions performing as the paired design. Results:The physical well-being, emotional well-being and the level of negative emotions such as anxiety and depression revealed signiifcant differences compared the patients who undergone BCS or IBR with those who undergone MRM in preoperative period (P0.05). At two and ifve years postoperatively, there was no signiifcant in the physical well-being, emotional well-being and negative emotions (P>0.05), whereas there was signiifcant differences in the other quality of life (P<0.05). Conclusion:BCS and IBR compared with MRM can obviously reduce the levels of preoperative negative emotions such as anxiety and depression, and improve the quality of life in long-term (two and ifve years postoperatively) to some degree.
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PURPOSE: As a recipient vessel, internal mammary vessels have many advantages for microvascular reconstruction of the breast. But the approach is time consuming and results in large morbidities. However, the perforating branches of the internal mammary vessels can be used to minimize such demerits. The purpose of this cadaver study is to clarify the location and diameter of the perforating branches of internal mammary vessels and to prove that they are safe and reliable recipient vessels. METHODS: We studied 11 formalin-fixed cadavers and dissected their anterior chests bilaterally. The chests were exposed using midline presternal incisions. We dissected and found all perforators at subfascial planes under loupe magnification. The number, external diameter, and the distance from the midline were measured. Result: The mean external diameter of the arterial perforators was 1.32mm and the mean external diameter of the venous perforators was 1.48mm. The largest arterial and venous perforators were most frequently found in the second intercostal space. The mean distance from the midline to the perforator was evaluated; the artery averaged 1.95cm and the vein averaged 2.08cm. CONCLUSION: This study will be helpful when using the internal mammary perforating vessels as a recipient vessel during breast reconstruction.
Subject(s)
Arteries , Breast , Cadaver , Glycosaminoglycans , Mammary Arteries , Thorax , VeinsABSTRACT
For the majority of patients with breast cancer, a surgery that minimizes breast loss combined with radiotherapy has become a popular treatment of choice. The wider clearance margins are necessary for the lower risk of local recurrences, although the greater amount of breast tissue should be removed and the risk of deformation of the breast is higher. Satisfactory cosmetic results can be achieved by oncoplastic breast surgery. The aims of this paper are to review articles of oncoplastic surgery for breast cancer and to summarize the full range of immediate reconstructions from local flaps to sophisticated perforator flaps. It is important for a surgeon to minimize breast loss while the operation and maintain the patient's feeling that her breasts are still a part of her own body after the operation. The oncoplastic breast surgery will become an integral element of the surgical treatment of breast cancer in the future.
Subject(s)
Female , Humans , Breast , Breast Neoplasms , Cosmetics , Mammaplasty , Mastectomy, Segmental , Perforator Flap , RecurrenceABSTRACT
La cirugía reconstructiva de mama ofrece a las pacientes alivio en síntomas secundarios a deformidades ocasionadas por tumores que, a pesar de ser benignos como en el caso de algunos tumores phyllodes, alteran la calidad de vida por ocasionar dolor, deformidad y dificultades con la ropa. Estos síntomas son proporcionales al tama±o de la lesión y a la duración de la enfermedad. El manejo integral por un mismo equipo quirúrgico de expertos permite resecar por completo una lesión gigante benigna y la reconstrucción inmediata. Esto se hizo en una paciente de 39 años con un colgajo extendido del músculo dorsal ancho homolateral que reemplazó el volumen mamario resecado, la cobertura de la piel se realizó con tejido autólogo que se conservó durante el procedimiento quirúrgico de ablación del tumor. El resultado en cuanto al manejo de la enfermedad fue bueno; el tumor de 17x15x9 cm y 1000 g de peso que ocupaba 90% del seno se resecó en toda su extensión. El efecto estético de la reconstrucción inmediata tanto para la paciente como para el equipo quirúrgico, fue satisfactorio. Después de 30 meses de la cirugía; la paciente estß libre de síntomas y no ha habido recurrencia del tumor. Este manejo plantea la importancia de tener en cuenta los conceptos que se enuncian en la clasificación de la enfermedad benigna de la mama (ANDI) para los procedimientos quirúrgicos reconstructivos de tumores benignos en mujeres mayores de 35 a±os cuyo tejido mamario ya inició su involución.
Immediate breast reconstructive surgery offers to a patient relief in secondary symptoms due to deformities caused by tumours that in spite of the fact of being harmless, for instance in some phyllodes tumours, alter life quality since they produce pain, malformations and inconveniences to clothesÆ employment. These symptoms are in proportion to lesion size and disease duration. Integral management by the same expertsÆ surgical team allows a complete resection of a benign giant lesion as well as an immediate reconstruction. The immediate breast reconstruction was performed in a 39 year old patient with a homolateral extended latissimus dorsi flap that replaced the breast volume removed; for skin covering an autologous tissue kept during surgical procedure for tumour ablation was used. Results related to disease management were adequate. The tumour, which measured 17x15x9 cm, weight 1000 g and occupied almost 90 per cent of the breast, was completely extirpated. Aesthetic result for patient (and for the surgical team) was acceptable and satisfactory. End outcome has persisted 30 months post-surgery; presently there are no symptoms and no tumour recurrences have been detected. This type of management establishes the importance of having in mind those concepts clearly given on breast benign pathology classification (ANDI) in order to follow reconstructive surgical techniques in women older tan 35 years, with benign tumours in whom breast tissuesÆ involution have already begun.