Immediate reconstruction after partial mastectomy

Abstract

Clinical trials at our institution and all over the world have proven that conservative surgery for small breast cancers is effective and safe. The aim of the procedures is to avoid, whenever possible, a useless mutilation to patients and to offer a good aesthetic outcome. In our view, the segmental mastectomy should be a locally “radical” procedure by means of a “wide” excision unlike the simple biopsy performed in the so called “tumorectomy.” For this reason about 15% of the patients present a poor cosmetic result worth improving by means of a plastic surgery procedure. Such unsatisfying cosmetic results are usually due to the extent of the excision compared with the size of the breast, the location of the cancer, and the effects of radiotherapy. Because it is our experience that delayed reconstructive procedures are limited by the effects of RT, it is preferable to achieve the best shape at the time of the primary surgical procedure (ie, to perform an immediate reconstruction). It is our philosophy that major reconstruction (ie, transfer of latissimus dorsi or rectus abdominis flaps) should be avoided whenever possible as a primary procedure. Indeed, it is unclear why a total mastectomy and a primary reconstruction should not be performed in these patients instead of having the double problem of facing the morbidity and the scars subsequent to the transfer of distant tissue and of leaving behind a good portion of potentially diseased breast tissue. A number of techniques suitable for the immediate repair of segmental mastectomy defects have been studied. They vary depending on the breast site involved and consist in rotation or advancement of dermoglandular flaps based on an inferior or superior pedicle. In selected cases, a custom-made segmental prosthesis has been used, as well as a latissimus dorsi flap.