Reconstructive surgery in breast cancer
Maurício Magalhães Costa, MD, MSc, PhD

Abstract

Breast reconstruction after mastectomy may be performed in the immediate or the delayed setting. Most patients undergoing mastectomy for prophylaxis or early stage breast cancer are candidates for reconstruction.
Immediate reconstruction, when feasible, generally provides superior cosmetic results, because a skin-sparing total mastectomy (SSM) or nipple-sparing total mastectomy (NSM) may be offered to selected patients, resulting in preservation of the native skin envelope and inframammary crease. However, when postmastectomy radiation is likely or a reconstructive surgeon is unavailable, delayed reconstruction following all adjuvant therapies may be recommended.
Reconstruction may be performed using implant-based methods, autologous tissue-based (termed flaps) methods, or a combination of the two. Implant-based approaches include tissue expanders and saline or silicone implants. Tissue-based approaches include the transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, and the deep inferior epigastric perforator (DIEP) flap.
Patients and physicians should have realistic expectations for breast reconstruction. Although excellent results may be achieved, often multiple operations are required for revisions, symmetry procedures, and nipple reconstruction. Complications related to reconstruction include an infected prosthetic implant, implant rupture, capsular contracture, flap necrosis, flap loss, fat necrosis, asymmetry, and scarring.
Some controversy remains whether the oncological or the plastic surgeon should perform reconstructive surgery. In many countries, most of great centers have the oncological and plastic surgeon working together in all cases of reconstruction. But the scenario is variable and depends on many different factors. Most of breast cancer patients in the world do not receive any kind of breast reconstruction. So there is a new arrangement in many countries in order to change this reality with the creation of a specialist breast surgeon who performs all kinds of reconstructions, the oncoplastic surgeon