• Breast reconstruction is increasing in popularity
• Can be performed as immediate or delayed procedure
• Breast reconstruction is oncologically safe
• Does not delay adjuvant therapy
• Does not delay the detection of recurrent disease
• There are no absolute contraindications
• Relative contraindications are old age, diabetes, smoker, collagen diseases
• Preoperative counseling is essential

Reconstructive options

• There are three types of breast reconstruction
  • Tissue expanders
  • Pedicled myocutaneous flaps 
  • Free tissue transfer
• Each has specific uses and complications
• The contralateral breast may require surgery to produce symmetry

Tissue expanders

• A simple and reliable technique
• When used alone often produce a poor cosmetic result
• Capsular contracture can result in firmness and discomfort
• Capsulectomy and replacement of the implant may be required
• Radiotherapy may increase the risk of capsular contracture
• Textured implants reduce the risk of capsule formation

Pedicled myocutaneous flaps

• The two commonest flaps are:
  • The latissimus dorsi flap based on the thoracodorsal vessels
  • The pedical transverse rectus abdominis based on the superior epigastric vessels
• Pedicled flaps produce a better cosmetic result
• Use of an LD flap is often combined with tissue expander or prosthesis
• TRAM flaps often provide enough autologous tissue to avoid the need for a tissue expander
• General complications associated with flaps include necrosis and flap loss
• The LD flap leaves a scar on the back and some shoulder weakness
• TRAM flaps can result in abdominal donor site hernia and weakness

Nipple reconstruction

• Nipples can be reconstructed by:
  • Nipple sharing
  • Skate flaps
  • Labial grafts
  • Nipple tattooing
  • Prosthetic nipples

Bibliography

Antoniuk P M.  Breast reconstruction.  Obstet Gynecol Clin North Am 2002;  29:  209-223.

Patel R J, Webster D J T, Mansel R E, Hughes L E. Is immediate post-mastectomy reconstruction safe in the long-term? Eur J Surg Oncol 1993; 19: 372-375.

Corral C J, Mustoe T A. Controversy in breast reconstruction. Surg Clin North Am 1996; 76: 309-326.

Malata C M, McIntosh S A, Purushotham A D. Immediate breast reconstruction after mastectomy for cancer. Br J Surg 2000; 87: 1455-1472.

Rainsbury R M. Breast reconstruction - new techniques. In: Taylor I, Johnson C D eds. Recent advances in surgery 22. Churchill Livingstone, Edinburgh 1999. 17-30.