Recovery of body image after mastectomy is essential for physical and mental quality of life. Partial or total mastectomy deformities can be reversed by reconstructive surgical procedures. Young women with breast cancer have specific characteristics related to the age of onset of the disease, prognosis and reconstructive expectations. Patient individualization is the key to a successful breast reconstruction. Autologous and prosthetic reconstruction are the two main techniques used for breast reconstruction. Each reconstructive technique has its own indications, advantages and limitations. Timing of the surgery is primarily determined by the requirement for adjuvant radiotherapy, so an immediate or a delayed approach can be recommended. In patients in whom the need for adjuvant radiotherapy is in doubt, a delayed-immediate approach is the best to optimize aesthetic and oncologic outcomes. Prophylactic mastectomy is also being indicated in a growing number of patients. In these patients it is important to choose a similar reconstructive procedure on both sides to achieve breast symmetry.
We describe 2 patients who received ionizing radiation as part of a curative regimen for childhood malignancy which later developed basal cell carcinoma at an early age. They do not occur within the context of well-defined syndromes, such like basal cell nevus syndrome, albinism, or xeroderma pigmentosum. Basal cell carcinomas appears on radiated areas in older individuals, less often in younger patients, in which the period of latency between exposure to radiation and the appearance of basal cell carcinomas is shorter than in older patients. Our 2 cases presented a period of latency of 11 and 10 years. Radiated skin areas must be explored as part of the follow-up in children who received radiotherapy and should probably be maintained for life. The basal cell carcinoma in childhood is best treated by excision.
This anatomic and clinical study supports the use of the ipsilateral transverse rectus abdominis musculocutaneous (TRAM) flap over the contralateral TRAM flap for breast reconstruction. The costomarginal artery was constant in these dissections and supplied a vascular pedicle to the rectus abdominis muscle. Radiologic studies confirmed the communications between the costomarginal artery and the deep epigastric system, the same as between the costomarginal artery and the musculophrenic and intercostal arteries. The results of the clinical series confirmed the costomarginal artery as an alternative or adjuvant vascular pedicle of the deep superior epigastric artery in cases of potential lesion of the latter. The lack of pedicle tension because of the shorter distance to be transposed allowed a greater versatility in flap shaping and positively affected its aesthetic result. This fact made the authors change from the contralateral to the ipsilateral pedicled TRAM flap as the first option for autologous breast reconstruction because of vascular security.
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