Advances and surgical decision‐making for breast reconstruction

Abstract

In patients who undergo breast reconstruction after mastectomy, choosing the appropriate timing and the best method of reconstruction are essential to optimize outcomes and to minimize the potential for postoperative complications. At The University of Texas M. D. Anderson Cancer Center, the clinicopathologic factors that are used in the surgical decision‐making for breast reconstruction after mastectomy include the breast cancer stage, status of axillary sentinel lymph node, smoking status, body habitus, preexisting scars, prior radiation therapy, and planned or previous chemotherapy. Immediate breast reconstruction after mastectomy is preferable for patients who have a low risk of requiring postmastectomy radiation therapy (PMRT) (Stage I breast cancer). Delayed reconstruction may be preferable in patients who are deemed preoperatively to require PMRT (Stage III breast cancer) to avoid difficulties associated with radiation delivery after an immediate breast reconstruction. In patients who are deemed preoperatively to be at an increased risk of requiring PMRT (Stage II breast cancer), delayed‐immediate breast reconstruction may provide an additional option. The approach to breast reconstruction will need to be adapted to maintain an appropriate balance between minimizing the risk of recurrence and providing the best possible aesthetic outcomes as the indications for PMRT and other treatment modalities continue to change. Cancer 2006. © 2006 American cancer Society.

Patient satisfaction and health‐related quality of life after autologous tissue breast reconstruction

“…[30][31][32] Immediate breast reconstruction usually was offered to women with a strong family history or gene positivity for breast cancer, in situ breast cancer, or clinical stage I or IIA breast cancer. The technique of breast reconstruction was selected based on location/type of cancer, medical and surgical risk factors, need for adjuvant radiotherapy, availability of local and distant donor tissue, desired size of the reconstructed breast, and patient preference.…”

Impact of neoadjuvant chemotherapy on breast reconstruction.

“…Receipt of neoadjuvant chemotherapy is yet another consideration within this algorithm; for patients who receive neoadjuvant chemotherapy, the expander is left inflated for the 4-week to 6-week period between mastectomy and radiation. 23,27 Although these reports all contribute to our understanding about the appropriate times at which reconstruction should be offered to breast cancer patients, none characterize the frequency of actual receipt.…”

Immediate Versus Delayed Breast Reconstruction for Postmastectomy Patients. Controversies and Solutions

“…have to be considered like: cancer stage, tumour size and location, status of the axillary sentinel lymph node, smoking habit, body constitution, history of previous surgeries and radiotherapy, planned radiotherapy or chemotherapy, existing comorbidities and the patient's informed preference (11,17).…”

“…At the same time, the indications for radiotherapy have been extendedfor some patients with early breast cancer (11),in the detriment of immediate breast reconstruction surgery, leading not only to better technique and planning for radiotherapy adjuvant treatment, but also to improved algorithms for implantbased and autologous breast reconstructions (12,13,14,15,16).…”