Immediate Breast Reconstructions in Breast Cancer Patients

• Authors: Peter Hyza , Jiři Vesely , Luboš Dražan , Oldřich Coufal , Umar Choudry
• Languages of publication: EN

Abstracts

EN

In mastectomy women an immediate breast reconstruction has become a real option over the past several years. Like many other reconstructive procedures, breast reconstruction aims not only to restore body form and anatomy, but also to improve quality of life and emotional well-being.The aim of the study was to review the cases of mastectomies and immediate breast reconstructions within 8 years and propose a mastectomy-reconstructive protocol to be used and evaluated for the future.Material and methods. Since January 2001, 39 patients of average age 43.9 years underwent mastectomy for early breast cancer and subsequent immediate reconstruction. Patients had either the breast reconstructed with an abdominal flap at the time of mastectomy, or they had a two stage reconstruction with the expander placed during mastectomy procedure and subsequent silicone-gel implant placement. The retrospective chart review of the records of patients with diagnosis of breast cancer were reviewed for histology, tumor size and technique of reconstruction used. Based on the pictures of postoperative results and the chart review, the reconstructive protocol was proposed.Results. The number of patients having immediate reconstruction has significantly increased over the past three years compare to previous period form 2001 till 2005. Majority of the patients were treated for early breast cancers (DCIS - ductal carcinoma in situ or invasive cancer smaller than 2 cm). The vital tissue was used for the reconstruction in 27 patients(71%). Silicone gel implant/implants were used for reconstruction in 11(29%) patients. 23 reconstructions was bilateral for the diagnosis of high oncological risk of contralateral breast parenchyma. Best results were achieved in patients with bilateral breast reconstructions having skin sparing or nipple sparing mastectomy and not having postmastectomy radiation therapy.Conclusions. The immediate breast reconstruction seems to be a reasonable solution for many patients having mastectomy for early breast cancer, smaller than 2 cm and negative sentinel node biopsy (low risk for postmastectomy radiation therapy). We prefer skin sparing or nipple sparing mastectomy if possible. The reconstruction with abdominal tissue results in a good and time-stable results in majority of the cases.

Keywords

EN

immediate breast reconstruction; breast cancer; DIEP flap; TRAM flap; expander-implant

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2008
• Volume: 80
• Issue: 10
• Pages: 531-539

Dates

published

1 - 10 - 2008

online

20 - 10 - 2008

Contributors

author

Peter Hyza

• Clinic of Plastic and Aesthetic Surgery, St. Anna University Hospital, Medical Faculty of Masaryk University, Brno, Czech Republic

author

Jiři Vesely

• Clinic of Plastic and Aesthetic Surgery, St. Anna University Hospital, Medical Faculty of Masaryk University, Brno, Czech Republic

author

Luboš Dražan

• Clinic of Plastic and Aesthetic Surgery, St. Anna University Hospital, Medical Faculty of Masaryk University, Brno, Czech Republic

author

Oldřich Coufal

• Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic

author

Umar Choudry

• Department of Surgery, Division of Plastic Surgery, University of Minnesota, MN, USA

References

• Pusic AL, Chen CM, Cano S, et al. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg 2007 Sep 15; 120(4): 823-37; discussion 838-39. Review. PMID: 17805107 [PubMed - indexed for MEDLINE]
• Cunnick GH, Mokbel K. Oncological considerations of skin-sparing mastectomy. Int Semin Surg Oncol 2006; 3: 14.
• Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nippleareola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 2003; 238(1): 120-27. PMID: 12832974 [PubMed - indexed for MEDLINE].
• Laronga C, Kemp B, Johnston D, et al. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 1999; 6(6): 609-13. PMID: 10493632 [PubMed - indexed for MEDLINE].
• Sacchini V, Pinotti JA, Barros AC, et al. Nipplesparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg 2006; 203(5): 704-14. Epub 2006 Sep 11.PMID: 17084333 [PubMed - indexed for MEDLINE].
• Stevens LA, McGrath MH, Druss RG, et al. The psychological impact of immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg 1984; 73(4): 619-28.[PubMed][Crossref]
• Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 1983; 1(8322): 459-62.[Crossref][PubMed]
• Franchelli S, Leone MS, Berrino P, et al. Psychological evaluation of patients undergoing breast reconstruction using two different methods: autologous tissues versus prostheses. Plast Reconstr Surg 1995; 95(7): 1213-18; discussion 1219-20.[Crossref]
• Cederna PS, Yates WR, Chang P, et al. Postmastectomy reconstruction: comparative analysis of the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous flap versus breast implant reconstruction. Ann Plast Surg 1995; 35(5): 458-68.
• Alderman AK, Wilkins EG, Kim HM, et al. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2002; 109(7): 2265-74.[PubMed][Crossref]
• Khoo A, Kroll SS, Reece GP, et al. A comparison of resource costs of immediate and delayed breast reconstruction. Plast Reconstr Surg 1998; 101(4): 964-68; discussion 969-70.[Crossref]
• Langstein HN, et al. Breast Cancer Recurrence after Immediate Reconstruction: Patterns and Significance. Plast Reconstr Surg 2003; 111: 712.
• Howard MA, et al. Breast Cancer Local Recurrence after Mastectomy and TRAM Flap Reconstruction: Incidence and Treatment Options. Plast Reconstr Surg 2006; 117: 1381.
• Allweis TM, et al. Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy. Am J Surg 2002; 183: 218-21.
• Wright JL, et al. Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation for stage II-III breast cancer: treatment intervals and clinical outcomes. Int J Radiat Oncol Biol Phys 2008; 70(1): 43-50.[PubMed][WoS][Crossref]
• Fernando SA, Edge SB. Evidence and controversies in the use of post-mastectomy radiation. J Natl Compr Canc Netw 2007; 5(3): 331-38.
• Schechter NR, et al. Immediate breast reconstruction can impact postmastectomy irradiation. Am J Clin Oncol 2005; 28(5): 485-94.[Crossref][PubMed]
• Tran VN, Chang DW, Gupta A, et al. Comparison of Immediate and Delayed Free TRAM Flap Breast Reconstruction in Patients Receiving Postmastectomy Radiation Therapy. Plast Reconstr Surg 2000; 108: 78-82.
• Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: Recent trends adn therapeutic implications. Plast Reconstr Surg 2000; 105(3): 930-42.[Crossref]
• Jugenburg M, et al. Impact of radiotherapy on breast reconstruction. Clin Plast Surg 2007; 34(1): 29-23.[PubMed][Crossref]
• Cordeiro PG, et al. Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg 2004; 113(3): 877-81.[PubMed][Crossref]
• Kronowitz SJ, Hunt KK, Kuerer HM, et al. Delayed-Immediate Breast Reconstruction. Plast Reconstr Surg 2004; 113(6): 1617-28.[Crossref][PubMed]
• Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg 2004; 114(4): 950-60.[Crossref][PubMed]
• Chagpar AB, et al. Predicting patients at low probability of requiring postmastectomy radiation therapy. Ann Surg Oncol 2007; 14(2): 670-77. Epub 2006 Nov 10.[Crossref][WoS]
• Shaikh-Naidu N, Preminger BA, Rogers K, et al. Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction. Ann Plast Surg 2004; 52(5): 465-70; discussion 470.
• Alderman AK, Wilkins EG, Lowery JC, et al. Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg 2000; 106(4): 769-76.[PubMed]
• Alderman AK, Kuhn LE, Lowery JC, et al. Does patient satisfaction with breast reconstruction change over time? Two-year results of the Michigan Breast Reconstruction Outcomes Study. J Am Coll Surg 2007; 204(1): 7-12. Epub 2006 Nov16.

Identifiers

DOI

10.2478/v10035-008-0075-5