Breast reconstruction.

Breast reconstruction after mastectomy for breast cancer has usually been performed as a delayed procedure, often not less than one year after completion of postoperative radiation therapy and cytotoxic chemotherapy. The reason for delaying the procedure has been the increased risk of wound complications after the adjuvant therapy. The reconstruction has been even further delayed for patients with increased risk of recurrence in order to avoid a reconstruction 'in vain' for a patient, who will succumb to the disease within a couple of years after the reconstruction. The breast reconstruction can also be performed immediately in conjunction with the mastectomy. The rather slow acceptance of this procedure has mainly been for practical reasons. The mastectomies are usually performed by general surgeons. The operation has not been centralized to larger hospitals, and the patients usually want to have the operation performed as soon as possible. It is therefore often difficult to arrange a joint operation by the general and the plastic surgeons. In addition, suspicions have been raised that enlargement of the dissection area could spread cancer and increase the risk of local metastases. The same types of operation can be used for delayed and immediate breast reconstruction. There are basically two possible ways of creating a new breast mound. One entails transferring muscle, subcutaneous fat and skin into the area of reconstruction in sufficient quantity to shape a breast mound. The other possibility is to shape the breast mound mainly by inserting a prosthesis, similar in consistency to breast tissue into the area of reconstruction. For practical reasons the implant has to be covered by a sufficient amount of soft tissue, and for this purpose a number of pedicled flaps can be used. The implant most commonly used is made of silicone gel and covered by a membrane to prevent the gel from oozing into the surrounding tissues. A recent innovation is an implant with textured surface in order to diminish capsule formation around the prosthesis.

Adrenergic innervation of aortic patch-grafts in rats.

The regeneration of vascular adrenergic nerves was studied using the glyoxylic acid-induced fluorescence method for the specific demonstration of adrenergic nerves in syngeneic patch-grafts of the right atrium of the heart, vena cava and glutaraldehyde-treated vena cava transplanted into the abdominal aorta of the rat. Glutaraldehyde-treated segments of the supradiaphragmatic inferior vena cava were transplanted into the abdominal aorta of rats as well. At the end of the observation period of 24 weeks limited, patchy and defective innervation was observed in the syngeneic vena cava and atrial patches. No adrenergic nerves were found in the glutaraldehyde-treated vein patch-grafts or vein grafts. Owing to the very poor innervation of atrial and venous patch-grafts the results are not entirely in agreement with the target organ concept of adrenergic nerve regeneration. In this study the suture line around the patch graft probably hampers regeneration of vascular adrenergic nerves in the patches.

Degeneration and regrowth of adrenergic nerves after microvascular anastomosis. A fluorescence histochemical study on end-to-end anastomoses of femoral vessels in the rat.

The normal femoral artery and its branches were found to be innervated with a dense network of adrenergic nerves. The nerve plexus around the vein was sparse. Adventitial stripping of the femoral vessels, with or without division and reanastomosis, caused local disappearance of catecholamine fluorescence in the stripped area. The distal adrenergic innervation remained normal if the femoral nerve was left intact. Division of the femoral nerve, alone or in combination with blood vessel division and reanastomosis, caused total disappearance of catecholamine fluorescence from the adrenergic nerves of the entire distal neurovascular tree examined. At the end of the observation period of 36 weeks from the time of division of the nerve, artery and vein with subsequent microvascular anastomosis, numerous adrenergic nerves were observed to have crossed the suture line. The vascular nerve plexus around the femoral vessels was dense in places, but in other places sparse or absent. It seems that the reinnervation occurs not only over the suture line, but also together with other regenerating nerves from the adjacent tissues and by collateral sprouting from adjacent adrenergically normally innervated areas.