State-of-the-art breast reconstruction.

Many breast reconstruction procedures have been performed with success and satisfaction. These methods can be categorized as implant reconstruction, local tissue with implant, autologous tissue, and free flaps. Implant reconstruction, immediate or delayed, has been the easiest and most fulfilling experience for the surgeon and the patient. Local tissue with implant and autologous tissue are usually available to those patients with anterior chest tissue deficiency or those who prefer autologous tissue without the fear of implant material. Free flap reconstruction is often selected when no other procedures are appropriate for the patient. Individual procedures must be familiar to the patient and the surgeon. Other factors such as time involved, cost of hospital stay, recovery time, and associated complications are discussed in this article. Refinement and nipple areolar reconstruction are an intimate part of breast reconstruction, but these are usually the decisions made by the patient that must be respected.

Prophylactic mastectomy: pros and cons.

Patients to be considered for prophylactic mastectomy fall into two groups. The first group comprises those who have already had a mastectomy and are either contemplating reconstructive surgery or are concerned about the development of cancer in their remaining breast. Since the patient who has had a mastectomy and is interested in reconstruction is already in a high-risk group, she has discussed at the initial interview, the possibility of prophylactic mastectomy and reconstruction. The second group of patients considering a prophylactic mastectomy also fall into the high-risk group. They have not yet had a mastectomy but find that they are emotionally disturbed-by the constant finding of new masses, and many have also had a number of biopsies. The patients in the second group are usually referred by a physician or surgeon who has followed them for a long period of time, or they have come on their own because of their mental anguish. It is the second group of patients, especially, who need time to have discussed with them in detail all our current knowledge concerning their high-risk status. However, both groups of patients must on their own, after counseling, make the final decision whether or not to have a prophylactic mastectomy.

Breast reconstruction today.

Present surgical techniques and prostheses now permit any woman who has had a mastectomy to be reconstructed. Whether a woman should have breast reconstruction must be decided only after full discussion of prognosis and attainable goals with the woman herself. A variety of choices of procedure, timing, and extent of surgery are available.

Alternatives in reconstructive surgery after mastectomy.

The modern era of breast reconstruction began about ten years ago. Today, reconstruction is possible for any woman who has had a mastectomy. The decision should be made only after discussion with both the woman's ablative surgeon and her plastic surgeon. Today there are a number of alternative methods to breast reconstruction. These include the following possibilities: immediate reconstruction, simple correction of a disturbing scar, reduction of a large remaining breast to simplify proper fitting of an external prosthesis, simple creation of a mound on the mastectomy side, insertion of a special prosthesis to fill in the subclavicular area, and reconstruction of the areolar nipple complex. Where more radical surgery has been done, the use of a myocutaneous flap, and in some special situations, reconstruction by means of microvascular anastomosis may be carried out. Some of these methods can be used in combination to fit the needs of the individual woman. It is the plastic surgeon's desire to help in the team approach in the treatment of breast cancer and by making suggestions to the ablative surgeon to make final reconstruction easier. Additional benefit might be the patients willingness to present herself earlier if she knows that in the long run reconstruction can be carried out.

The present status of breast reconstruction following mastectomy in the female.

During the last 10 years increased interest has developed in reconstruction of the female breast following mastectomy. A number of methods of reconstruction are now available. These are immediate reconstruction by means of a silicone implant, delayed reconstruction by means of a silicon implant, use of local flaps with the silicone implant, and use of distant tissue and movement of tissue by microvascular anastomosis.The simplest and most efficient procedure is the one-stage reconstruction which consists of insertion of a silicone prosthesis approximately 6 months following the mastectomy. This can be combined, when necessary, with an elevation and reduction of the remaining breast and the reconstruction at the same time of an areolar and nipple complex.Reconstruction of the female breast in no way jeopardizes the survival of the patients. In addition, it may bring the patient to the surgeon sooner since the knowledge of reconstruction helps to reduce the woman's fear of mutilization.