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An introduction to the importance of breast reconstruction

Breast Cancer2011 Introduction Breast reconstruction after mastectomy remains an essential part of the treatment for breast cancer. The improvements in the outcomes of breast cancer treatment lead more women to be concerned about the appearance of their breasts when treatment is complete. Also, with the increase in screening for genetic mutations of the BRCA1 and BRCA2 genes, reconstruction after prophylactic mastectomy has become more common.

Studies have demonstrated that most women desire surgical breast reconstruction after mastectomy. Furthermore, since 1998, federal law has mandated that insurance companies cover breast reconstruction. Therefore, all health care providers who treat patients with breast cancer need to have a basic knowledge of the different types of breast reconstruction and inform their patients that such options are available. Excellent aesthetic results have been obtained with many types of breast reconstruction Fig.

Breast reconstruction has also been shown to provide psychological and emotional benefit to reconstructed patients.

Despite these facts, breast reconstruction rates after mastectomies are surprisingly low. This may be due in part to the lack of knowledge about breast reconstruction by oncologists and general surgeons who may incorrectly believe that it interferes with adjuvant treatment and detection of local recurrences.

Proper knowledge of the benefits and risks of breast reconstruction should improve the rates of referral of mastectomy patients to plastic surgeons and the rate of reconstruction.

Reconstruction of the breast after mastectomy is an option that should be given to all breast cancer patients. Breast reconstruction should be discussed with any patient who is considering the treatment options of lumpectomy versus mastectomy.

It should also be part of every discussion about prophylactic mastectomy.

Diagnostic Immobilier Rouen

The knowledge of reconstruction options gives patients the information they need to make an educated decision about their choices in breast cancer therapy. The federal law mandating that insurance companies cover mastectomy be required to also cover reconstruction should alleviate patient concerns over the cost of reconstruction. The choices for breast reconstruction are numerous and involve many factors. Breast reconstruction involves either volume replacement e. In addition, breast reconstruction can be further categorized into 1 immediate versus delayed reconstruction and 2 prosthetic versus autologous reconstruction.

It is important for health care providers to know that there is no single best choice for breast reconstruction. Each patient has a best option based on her needs, wishes, and the size and shape of her breast.

  • Of the 17 patients with necrosis, 13 76;
  • Capsular contracture and infections are the most common complications7;
  • This operation seeks to preserve abdominal wall strength and function.

Ultimately, the decision regarding the optimal type of breast reconstruction for an individual should be made between the patient and the reconstructive surgeon. The need for adjuvant therapy and the desire to augment the contralateral breast in unilateral mastectomy are also important factors in determining the best option for patients.

Breast reconstruction

All of these issues, the risks and benefits of each, and the expectations of the patient should be fully discussed with a plastic surgeon before a decision is made about the type of breast reconstruction. The options for patients who choose breast reconstruction have increased over the last four decades. Implant reconstruction has been available since the 1960s, and the cosmetic results have improved with new plastic surgery techniques and improvements in newer generation of breast implants.

In the 1970s and 1980s, pedicled flaps were developed and used in breast reconstruction. Over the last two decades, advancements in microsurgical techniques have led to free tissue flaps and perforator tissue flaps in which a portion of the body and its blood supply are detached, transferred to the chest, and reconnected to blood vessels at the recipient site.

These advancements have helped to reduce donor site morbidity and to increase the options for patients pursuing breast reconstruction.

Breast reconstruction

The total course of breast reconstruction almost always involves more than one procedure. In either the implant or autologous tissue pathway, the first procedure involves transferring tissue or placing an implant or expander to give the reconstructed breast volume and shape for symmetry. After this is complete, secondary procedures are carried out 3 to 6 months later to modify the shape, size, and scars of the breast.

A nipple-areola complex can also be reconstructed at this time. Finally, tattooing of the nipple-areola complex is performed, usually under local anesthetic, resulting in the final reconstructed breast. It is important for all patients considering breast reconstruction to know that more than one procedure is necessary to achieve the final appearance and that this can take up to 1 year to complete.

Breast-conserving therapy is now a common way to treat early-stage breast cancer. Patients who undergo breast-conserving therapy with lumpectomy may suffer from postoperative breast deformities.

Several techniques are also available for partial breast reconstruction to treat these patients.

  • This is an important factor for plastic surgeons when replacing a breast with an implant and hoping to achieve balanced, proportional result;
  • Though there will always be people who do not opt for reconstruction or who are not candidates, current techniques ensure that the vast majority of people who desire reconstruction after mastectomy will be able to be reconstructed with the goal of a balanced and aesthetic result;
  • For salvage reconstructions, myocutaneous flaps were primarily used, and most of the new interventions were performed by professionals other than those who performed the first surgery;
  • Breast reconstruction is an elective optional surgery for women that have had their entire breast mastectomy , or part of their breast lumpectomy , removed this type of it can have psychological and physical benefits, and may let you avoid the use of an artificial breast what are my breast reconstruction options.

The decision about reconstructive options is best made for each individual patient by the patient and her reconstructive surgeon. Reconstruction after mastectomy increases the operative time, blood loss, and prolongs recovery.

The method of breast reconstruction depends on patient preference, the shape and size of the native breast, the condition of the recipient site, the availability of donor sites, the patient's comorbidities, and the expertise of the plastic surgeon. Regardless of the reconstruction method, the technique used during mastectomy is important in achieving adequate symmetry. Maintaining the skin envelope and the inframammary fold guides size and preserves landmarks for breast positioning.

Three types of mastectomy techniques allow this. Skin-sparing mastectomy is resection of the breast tissue and the nipple-areola complex that still preserves the breast skin envelope and inframammary fold.

An introduction to the importance of breast reconstruction

Areola-sparing mastectomy is similar, but also preserves the areola with resection of the nipple. Subcutaneous mastectomy, which is offered in prophylactic mastectomy, preserves the entire nipple-areola complex.

  • Although not clearly defined as a risk factor11, chemotherapy is believed to impair cellular functions required for postoperative recovery, leading to unfavorable results12;
  • Although reconstructive plastic surgery cannot reproduce a normal breast, the aim is to recreate as accurate a likeness as possible which helps to restore a sense of wholeness and balance breast reconstruction is a very detailed and complex subject the information here is intended simply as an introduction to a much;
  • Are you ok with having more surgery for breast reconstruction after mastectomy or lumpectomy it's also important to know that while breast reconstruction rebuilds the shape of the breast, it doesn't restore sensation to the breast or the nipple over time, the skin over the reconstructed breast can become;
  • Nevertheless, the development of techniques to harvest the excess skin and fat of the lower abdomen, while preserving muscle strength and function is one of the most exciting new developments in this field;
  • Reconstruction after mastectomy increases the operative time, blood loss, and prolongs recovery;
  • Paralleling the development of refined techniques for transferring tissue, techniques for breast reconstruction have advanced dramatically in the last several years.

Note that skin-sparing mastectomy does not increase the incidence of local recurrence rates when compared with simple mastectomy Table 13-1.