Breast reconstructive techniques in cancer patients: Which ones, when to apply, which immediate and long term risks?

TY - JOUR

T1 - Breast reconstructive techniques in cancer patients

T2 - Which ones, when to apply, which immediate and long term risks?

AU - Petit, Jean Yves

AU - Rietjens, Mario

AU - Garusi, Cristina

PY - 2001/6

Y1 - 2001/6

N2 - Breast reconstruction is considered as part of the breast cancer treatment when a mastectomy is required. The techniques available today, allow reconstruction of the breast even in almost all the cases even in poor local conditions. In 60-70% of the cases, the reconstruction can be performed with an implant inserted behind the pectoralis muscle. Special implants called expanders, are inflatable progressively in the postoperative course thanks to a reservoir located subcutaneously. They provide a progressive distention of the teguments and a more natural shape after substitution of the expander with a definitive implant. The symmetry is usually obtained thanks to a contralateral plastic surgery, which allows at the same time histological check up of the glandular tissue of the opposite breast. The nipple areolar complex is usually reconstructed in a second stage under local anesthesia, using local flaps for the nipple and a tatoo for the colour of the areola. In 30% of the cases, especially after radiotherapy when a salvage mastectomy is required, a flap reconstruction is preferred. The autologous tissue reconstruction with the rectus myocutaneous flap gives excellent cosmetic results and the most natural shape for the breast. But it is a more demanding technique requiring a good experience. In some occasions, the reconstruction with the latissimus flap can also be autologous but usually requires the addition of prosthesis. In most cases, the reconstruction can be performed immediately. The delayed reconstruction is usually preferred when the adjuvant chemotherapy should be delivered as soon as possible after the mastectomy. Complications of the reconstruction such as local necrosis or infections, leading to implant removal or revision of the flap could be detrimental to the patient in delaying the start of the chemotherapy. It is not recommended to reconstruct the breast immediately in case of locally advanced breast cancer. Partial breast reconstruction using plastic surgery procedures can also be performed in case of quadrantectomy in order to obtain a better cosmetic result. Local glandular flaps, as well as specific incisions according to the location of the tumor in the breast allow the reshaping of the breast even in case of large resection and, therefore, provide an opportunity to increase the number of conservative treatment indications, especially in case of in-situ carcinomas.

AB - Breast reconstruction is considered as part of the breast cancer treatment when a mastectomy is required. The techniques available today, allow reconstruction of the breast even in almost all the cases even in poor local conditions. In 60-70% of the cases, the reconstruction can be performed with an implant inserted behind the pectoralis muscle. Special implants called expanders, are inflatable progressively in the postoperative course thanks to a reservoir located subcutaneously. They provide a progressive distention of the teguments and a more natural shape after substitution of the expander with a definitive implant. The symmetry is usually obtained thanks to a contralateral plastic surgery, which allows at the same time histological check up of the glandular tissue of the opposite breast. The nipple areolar complex is usually reconstructed in a second stage under local anesthesia, using local flaps for the nipple and a tatoo for the colour of the areola. In 30% of the cases, especially after radiotherapy when a salvage mastectomy is required, a flap reconstruction is preferred. The autologous tissue reconstruction with the rectus myocutaneous flap gives excellent cosmetic results and the most natural shape for the breast. But it is a more demanding technique requiring a good experience. In some occasions, the reconstruction with the latissimus flap can also be autologous but usually requires the addition of prosthesis. In most cases, the reconstruction can be performed immediately. The delayed reconstruction is usually preferred when the adjuvant chemotherapy should be delivered as soon as possible after the mastectomy. Complications of the reconstruction such as local necrosis or infections, leading to implant removal or revision of the flap could be detrimental to the patient in delaying the start of the chemotherapy. It is not recommended to reconstruct the breast immediately in case of locally advanced breast cancer. Partial breast reconstruction using plastic surgery procedures can also be performed in case of quadrantectomy in order to obtain a better cosmetic result. Local glandular flaps, as well as specific incisions according to the location of the tumor in the breast allow the reshaping of the breast even in case of large resection and, therefore, provide an opportunity to increase the number of conservative treatment indications, especially in case of in-situ carcinomas.

KW - Breast cancer

KW - Breast reconstructions

KW - Conservative surgery

KW - Free flaps

KW - Implants

KW - Myocutaneous flaps

KW - Plastic surgery

KW - Timing of reconstruction

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UR - http://www.scopus.com/inward/citedby.url?scp=0035013678&partnerID=8YFLogxK

U2 - 10.1016/S1040-8428(00)00137-2

DO - 10.1016/S1040-8428(00)00137-2

M3 - Article

C2 - 11369256

AN - SCOPUS:0035013678

VL - 38

SP - 231

EP - 239

JO - Critical Reviews in Oncology/Hematology

JF - Critical Reviews in Oncology/Hematology

SN - 1040-8428

IS - 3

ER -