Post-mastectomy breast reconstruction

Abstract

tion options with patients, irrespective of whether they are available locally. 6 Fifty three per cent of women having surgery for breast cancer will undergo mastectomy (box 1). 7 8 In the UK and United States, bilateral mastectomy is increasingly being used for risk reduction in BRCA carriers, for those with a high risk of developing breast cancer (lifetime risk of 30%), or as a planned management strategy for unilateral cancer (fig 1, bmj.com). 9-15 In general, bilateral mastectomy is associated with a higher rate of breast reconstruction. A recent Cochrane review showed that bilateral prophylactic (risk reduction) mastectomy reduced the incidence of, and death from, breast cancer, but it highlighted that more rigorous prospective studies are needed to assess absolute risk reduction. 16 The review also found that although contralateral prophylactic (risk reduction) mastectomy decreases the incidence of cancer in the contralateral breast, it is unclear whether, and for whom, this practice improves survival. 16 How is a mastectomy performed?When performing a mastectomy, the anatomical (oncological) plane between breast tissue and subcutaneous fat needs to be identified. It is, however, impossible to remove all breast tissue because the oncological plane is not uniform throughout the breast. A standard (simple) mastectomy removes the breast skin envelope, but a skin sparing mastectomy preserves the breast skin envelope Breast cancer is the most common cancer in women, with almost 1.38 million new cases a year worldwide; it accounts for 23% of all cancers and 14% of deaths from cancer. 1 However, mortality from breast cancer is d eclining-increasing numbers of women are long term survivors (>5 years) (currently 549 000 in the United K ingdom). 2 3 Surgery remains a mainstay of treatment, either breast conservation or mastectomy, but any breast surgery can greatly alter breast aesthetics and body image.Breast reconstruction restores breast symmetry after a mastectomy by creating a breast mound, similar in size, shape, contour, and "out of bra position" to the contralateral breast. In England and Wales in 2002, about 10% of women had immediate breast reconstruction; by 2009 this had risen to 21%. 4 Post-mastectomy breast reconstruction is associated with improved body image, quality of life, self confidence, and wellbeing. 5 In this review, we outline the indications for breast reconstruction along with the timing and techniques available to patients after mastectomy. What is post-mastectomy breast reconstruction?Breast reconstruction is a surgical procedure that restores shape to the breast after mastectomy. Although it will not re-create the exact look and feel of a natural breast, it aims to create a breast mound contour similar to that before mastectomy. When, and to whom, should breast reconstruction be offered?In 2009 the National Institute for Health and Clinical Excellence (NICE) revised guidance on improving breast cancer outcomes. It recommended discussing immediate reconstruction with all patients ha...

Development of a core outcome set for research and audit studies in reconstructive breast surgery

“…Decision‐making in RBS, however, can be difficult. There are several procedures available, ranging in complexity from expander/implant‐based reconstructions to more challenging autologous procedures. Factors such as body habitus, co‐morbidities and the need for postoperative radiotherapy may influence the choice of reconstructive method.…”

Time to be BRAVE: is educating surgeons the key to unlocking the potential of randomised clinical trials in surgery? A qualitative study

“…Breast reconstruction (BR) after mastectomy for breast cancer is one such example, where possible interventions include simple implant-based reconstruction, pedicled flap reconstruction including the latissimus dorsi flap, or free flap procedures such as the deep inferior epigastric perforator (DIEP) flap using skin and fat from the lower abdominal wall [11,12]. Since 1995, just 13 BR RCTs [13-24] have been conducted and only 2 have addressed major questions such as the optimal type [24] or timing [25] of surgery.…”

The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: A critical review

“…Despite breast cancer being the most common cancer in women globally, mortality from the disease is decreasing; earlier detection and developments in treatment have led to an increase in survival rates (Cho et al, 2014;Ditsch et al, 2013;Thiruchelvam, McNeill, Jallali, Harris, & Hogben, 2013;Winters et al, 2012).…”

“…The UK National Institute for Health and Clinical Excellence (NICE) recommends that reconstruction should be available to all women with breast cancer at the initial surgery (Winters et al, 2012). There are many reconstructive methods available and the main techniques used for breast reconstruction include; implants, autologous tissue, or a combination of the two (Fodor et al, 2011;Thiruchelvam et al, 2013). Reconstruction surgery can be performed immediately or delayed, with procedures varying in surgical complexity, recovery time and associated complications (Fraser, Fayater, & Achuthan, 2013;Spector et al, 2011).…”