Breast reconstruction: current and future options

Abstract

Abstract:When initiated by the devastating diagnosis of cancer, post ablative breast restoration has at its core the goal of restoring anatomic normalcy. The concepts of body image, wholeness, and overall well-being have been introduced to explain the paramount psychological influence the breast has on both individuals and society as a whole. Hence, a growing subspecialty has been established to recreate or simulate the lost breast. At least one third of breast cancer victims consider breast reconstruction. Breast reconstruction post mastectomy may be offered at the time of mastectomy or delayed post mastectomy after adjuvant therapy. This may be utilizing autologous tissues or implants and each has risks and benefits, especially when considering adjuvant therapy. In addition, there has been a move away from a traditional mastectomy to less invasive, but still curative procedures, such as skin-sparing and nipple-sparing mastectomy. These procedures provide the breast envelope to facilitate reconstruction. This paper reviews the primary issues in breast reconstruction, as well as their psychologic, oncologic, and social impact. Keywords: breast restoration, body image, breast reconstruction, mastectomy History of breast reconstructionBreast cancer is the second leading cause of cancer-related death among females in the US, and affects one in eight women in their lifetime.1,2 Advances in medical research have dramatically improved the treatment of this disease over the last 50 years. In addition to chemotherapy and radiation therapy, partial and complete mastectomy of diseased and contralateral breasts has become more frequent. However, these surgical modalities often leave patients with anatomical deformities and altered body image, along with the psychologic impact. 3,4 Breast reconstruction is a dynamic and multidisciplinary approach that has grown into a solution for many breast cancer patients treated with surgery. Breast reconstruction began as a means to reduce chest wall complications and deformities from mastectomy, with the goal to recreate symmetry and contour while avoiding delay in adjuvant cancer treatment.1 Breast reconstruction was introduced over a century ago as a surgical modality for rebuilding the anatomic breast using autologous tissues and prosthetic implants. 2,5

Post Nipple-Sparing Mastectomy Reconstruction: Renewed Popularity of Latissimus Dorsi Flap for More Cosmetically Appealing Results

“…The breast reconstruction using autogenous tissue has its own indications in multiple situations, including [10] ptotic contralateral breast, previous radiation or previous failed reconstruction by implants [6]. The latissimus dorsi flap was used in breast reconstruction either with or without implants.…”

“…Although breast reconstruction can change the life style of the patient, it has its associated risk and complications which are continually studied to be minimized and to enhance the surgery of breast reconstruction [10].…”

Natrelle Silicone Breast Implant Follow-up Study

“…1 A primary, growing reason for breast reconstruction is to restore breasts to their presurgical form following mastectomy due to breast cancer. 2 – 5 Breast reconstruction is also used to correct congenital deformities, malformations, and trauma to the breast. 6 , 7 Natrelle silicone gel-filled breast implants (Allergan, Irvine, Calif.) are available in a range of implant options and are approved by the US Food and Drug Administration (US FDA) for primary reconstruction and revision-reconstruction as well as for primary augmentation and revision-augmentation.…”