Breast Reconstruction after Breast Cancer

Abstract

Breast cancer is unfortunately a common disease affecting millions of women, often at a relatively young age. Reconstruction following mastectomy offers women an opportunity to mollify some of the emotional and aesthetic effects of this devastating disease. Although varying techniques of alloplastic and autologous techniques are available, all strive to achieve the same goal: the satisfactory reformation of a breast mound that appears as natural as possible without clothing and at the very least is normal in appearance under clothing. This article summarizes the various approaches to breast reconstruction and offers a balanced view of the risks and benefits of each, all of which in the end offer the opportunity for excellent and predictable results with a high degree of patient satisfaction.

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

“…Technically easier procedure with shorter operating time [129] Lower initial costs than autologous methods ($15,497) [129,133] Less invasive and no donor site complications [129,130] May require revision surgery to achieve optimal aesthetic outcome [129,130] The need for subsequent procedures substantially increases overall cost compared to autologous methods and the initial cost savings may be lost [129] Complications include haematoma, infection, extrusion and capsular contracture, leak and rupture Appearance is less natural than autologous reconstructions. Breast asymmetry often requires modification procedure to be performed on the contralateral breast [129,130] Implants will eventually leak, thus one or more implant exchanges may be required in a lifetime [130] Risk of complications is significantly increased by radiation [131] Table 2 Comparison of the advantages and disadvantages of the common recipient vessels for autologous breast reconstruction Vessel Advantages…”

“…Good volume [130] Reliable blood supply [130] Free TRAM flaps can create reconstructions that are as aesthetically pleasing as DIEP flaps [131] Greater abdominal wall morbidity than DIEP flaps resulting in hernia (2.6%) or abdominal bulge (3.8%), especially in obese patients Decreased abdominal wall strength [129,121] Common methods of breast reconstruction post-mastectomy Latissimus Dorsi flap Robust blood supply [130,131] Good salvage option for re-operations [130,131] A readily available option for almost all patients [131] Limited volume compared to DIEP and TRAM flaps …”

“…Minimally impact on abdominal wall function as fascia is no disrupted [130,131] Limited volume [130,131] Tenuous blood supply [130] Higher rates of flap loss (2.9%) and re-operation (17.4%) [136] Not suitable for women with inadequate abdominal adiposity [132] Two-stage reconstruction (expander plus implant) Requires less skin than single-stage reconstructions [129] Multiple consultations required over several months [129,130] Tissue expanders require muscle coverage to prevent extrusion and to achieve adequate bulk [129,130] Additional procedure required to replace expander with implant [130] Non-autologous (Implant-based)…”

Analysis of patient satisfaction and donor-site morbidity after different types of breast reconstruction

“…This discrepancy could be explained by the difference in follow-up, which was on average 23.3 months in Colakoglu et al's study versus 38.4 months in our study. It has been well documented that postreconstruction satisfaction rates decline over time (23). Therefore, when analyzing long-term patient satisfaction, it might be increasingly more difficult to show differences in satisfaction.…”

The Surprise of a Breast Reconstruction: A Longitudinal Phenomenological Study to Women’s Expectations About Reconstructive Surgery

“…In most of the implant reconstructions, a saline or silicone implant is placed beneath the skin. A breast reconstruction with one's own body tissue, a so called (free) flap-procedure, involves the removal of skin, muscle and fat from another part of the body, such as the abdomen, back or hip, and its transfer to the chest wall (Serletti et al 2011). Other than with an implant reconstruction, a flap-reconstruction gets bigger or smaller when the body gains or loses weight.…”