Immediate breast reconstruction – a review of indications, techniques and results

Abstract

BACKGROUND: It has only been during the last decade that immediate breast reconstruction has become accepted as an integrated part of the treatment concept of breast cancer in Austria. The involvement of the plastic surgeon in the planning of treatment at the time of the diagnosis of breast cancer is still far from standard. The aim of this review article is to make it more widely known that immediate breast reconstruction is a choice for the majority of women undergoing complete breast removal or greater disfiguring resections of the breast gland and does not have any negative influence on the oncological late outcome. METHODS: On the basis of a review of the international literature and our own prospective studies on breast reconstruction, the actual indications and contraindications for immediate reconstruction are outlined. Having analysed patients of the Division of Plastic and Reconstructive Surgery at the Department of Surgery at the Medical University of Vienna for the last 15 years, the evolution of immediate breast reconstruction and of the methods applied is described. Special attention is paid to the biology and the course of the tumour disease, to the possible interference with adjuvant therapies, to the influence of age, and to the selection of the operative technique depending the individual situation. RESULTS: All major studies of local recurrence rate and survival rate after immediate breast reconstruction have ruled out any negative effect on the oncological course. Therefore information on the possibility of immediate breast reconstruction has to be passed on to every breast cancer patient at the time of diagnosis. This information has to include the whole range of techniques offered by plastic surgeons for breast preserving surgery, from the local glandular mammaplasty, the reduction mammaplasty for tumor resections in bigger breasts, the partial reconstruction with a myocutaneous latissimus dorsi flap to the reconstruction with a breast implant. In the case of a mastectomy, usually as skin-sparing mastectomy, again the whole spectrum of reconstructive approaches has to be discussed with the patient from the very beginning: the Deep Inferior Epigastric Perforator Flap (DIEP – flap), the Transverse Rectus Abdominis Myocutaneous Flap (TRAM – flap), and the extended latissimus dorsi myocutaneous flap for autologous breast reconstruction, or with the involvement of a breast implant. The immediate breast reconstruction with autologous tissue has become the procedure of first choice, because the disadvantages of the use of implants in the case of necessary postoperative irradiation therapy can be avoided. CONCLUSIONS: Information on all reconstructive possibilities should be passed on by the plastic surgeon to the patient needing a resection of the whole or a greater part of the breast because of breast cancer at the time of diagnosis so as not to miss the chance of immediate reconstruction if preferred by the patient.