Over the past 15 years, breast reconstruction has undergone a significant evolution. Controversies involving implant safety, new implant design, flap design, the increased use of radiation to treat breast cancer, and the pursuit of more aggressive breast-conserving surgeries have significantly influenced breast reconstruction procedures. Determining the optimal time and method of breast reconstruction cannot be reduced to an algorithm. Careful consideration of the patient’s disease profile as well as her objectives and understanding of reconstruction options are critical.

RECONSTRUCTION PROCEDURE PREFERENCES

The final degree of satisfaction of the woman is not always in agreement with the evaluation of the medical staff for which the shape and the symmetry of the reconstructed breast are the two main criteria. For this reason, the cosmetic aspect of the final result of the reconstruction cannot be the only criteria to chose the technique. Although the TRAM flap provides usually the best cosmetic results, there are patients who do not support the changes that result on the morphology and the function of their abdomen wall. Therefore, the choice of the technique should take in consideration both the technical difficulties and the psychological reactions of the woman when she is informed before the operation. It is of major importance to understand what are the expectations of the patient in order to maximize her final satisfaction.

—Petit JY et al. Critical Reviews in
Oncology/Hematology 2001;38:231-239. Abstract

TIMING OF RECONSTRUCTION

Immediate reconstruction has been shown to yield the greatest patient benefit and should be the treatment of choice for most patients. However, delayed reconstruction is preferable for patients who are unable to make a sound decision regarding reconstruction at the time of mastectomy.

—Shons A, Mosiello G. Cancer Control
2001;5(8):419-426. Full-Text

In the past, the use of immediate or early breast reconstruction after mastectomy was an unpopular concept. Concerns about potentially compromising the surgical resection for the sake of reconstruction and the possibility of a decreased ability to detect local recurrences were used to justify delaying reconstruction for several years after mastectomy.

In addition, techniques for breast reconstruction had not been fully developed. Multiple procedures were required, hospital stays were prolonged, and end results were not consistently esthetically pleasing. Today, these concerns should no longer be significant barriers to the use of reconstruction.

Many retrospective studies have demonstrated that the use of postmastectomy reconstruction does not interfere with the ability to detect local recurrence, nor does it delay the administration of adjuvant chemotherapy. In addition, the use of skin-sparing mastectomy coupled with advances in plastic surgical technique, has resulted in a variety of reconstruction options with improved esthetic outcomes.

—Morrow M et al. J Am Coll Surg
2001;(192)1:1-8. Abstract

INFLUENCE OF GEOGRAPHIC REGION ON USE OF IMMEDIATE BREAST RECONSTRUCTION NORTHEAST: Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, and New Jersey SOUTHEAST: Delaware, District of Columbia, Maryland, West Virginia, Virginia, North Carolina, South Carolina, Georgia, and Florida MIDWEST: Wisconsin, Michigan, Illinois, Indiana, Ohio, Minnesota, North Dakota, South Dakota, Iowa, Nebraska, Kansas, and Missouri SOUTH: Kentucky, Tennessee, Mississippi, Alabama, Oklahoma, Arkansas, Texas, and Louisiana MOUNTAIN: Montana, Idaho, Wyoming, Nevada, Utah, Colorado, Arizona, and New Mexico; PACIFIC: Washington, Oregon, California, Alaska, and Hawaii Adapted from Morrow, et al. J Am Coll Surg. 2001;192(1):1-8 Abstract     USE OF IMMEDIATE BREAST RECONSTRUCTION BY AGE   < 50 50-69 >70 n=155,463 (1985 - 1990) 1.7% 3.4% 6.7% n=63,348 (1994 - 1995) 4.2% 7.9% 14.6%   USE OF IMMEDIATE BREAST RECONSTRUCTION BY INCOME   <$ 20,000 $20,000 - $46,999 $47,000 + n=155,463 (1985 - 1990) 8.1% 3.0% 0.5% n=63,348 (1994 - 1995) 17.9% 7.8% 1.3% Adapted from Morrow, et al. J Am Coll Surg. 2001;192(1):1-8 Abstract What would you generally recommend for the following women with 2 cm breast masses which on core biospy prove to be poorly-differentiated ER-negative, infiltrating ductal carcinoma? S U R G E O N S   43-YEAR-OLD 43-YEAR-OLD WITH PRIOR HYSTERECTOMY AND A HORIZONTAL INCISION 62-YEAR-OLD TYPE Implants 25% 45% 60% Latissimus dorsi 25% 40% 15% TRAM flap 50% 15% 25% TIMING Immediate 65% 60% 50% 3-6 months 5% 10% 25% After 6 months 25% 25% 20% 2 years 5% 5% 5%

Chang DW et al. Reconstructive management of contralateral breast cancer in patients who previously underwent unilateral breast reconstruction. Plast Reconstr Surg 2001;108:352-8; discussion 359-60. Abstract

JY Petit et al. Breast reconstructive techniques in cancer patients: Which ones, when to apply, which immediate and long term risks? Critical Reviews in Oncology/Hematology 2001; 38:231-239. Abstract

Morrow M et al. Factors influencing the use of breast reconstruction postmastectomy: A National Cancer Database Study. J Am Coll Surg 2001:(192)1;1-8. Abstract

Nissen MJ et al. Quality of life after breast carcinoma surgery: A comparison of three surgical procedures. Cancer 2001;91:1238-46. Abstract

Shons A,Mosiello G. Postmastectomy breast reconstruction: Current techniques. Cancer Control 2001;(8)5:419-426. Full-Text

Polednak AP. Type of breast reconstructive surgery among breast cancer patients: A population-based study. Plast Reconstr Surg 2001;108:1600-3. Abstract

Rowland et al. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 2000; 92:1422-1429. Abstract

Home | Meeting Workbook | Educational Supplement | Posters | Opinion Survey |