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—Breast reconstruction began as a means to reduce chest wall complications and deformities from mastectomy.

—   Breast reconstruction began as a means to reduce chest wall complications and deformities from

—Reconstruction has now been shown to benefit women in terms of psychological well- being and quality of life.

To re-create form and symmetry while avoiding delay in adjuvant cancer treatment.
To re-create form and symmetry while avoiding delay in adjuvant cancer treatment.

To re-create form and symmetry while avoiding delay in adjuvant cancer treatment.

—Preoperative counseling regarding reconstruction options should include the timing, type and alternatives to surgical reconstruction and realistic expectations.

—   Preoperative counseling regarding reconstruction options should include the timing, type and alternatives to surgical

—The plastic surgeon and surgical oncologist must maintain close communication to achieve optimal results

TIMING of breast reconstruction:
TIMING of breast reconstruction:
TIMING of breast reconstruction: Immediate reconstruction —   Initiation of reconstruction at the time of the

Immediate reconstruction

—Initiation of reconstruction at the time of the ablative surgery.

—Takes advantage of the preserved supple skin envelope made possible by skin- sparing mastectomy approach.

—Done in patients with early-stage disease

(low expectation of post-op radiotherapy).

Advantage

—Allows a more aesthetically pleasing and symmetric reconstruction.

Advantage —   Allows a more aesthetically pleasing and symmetric reconstruction. —   Patient avoids the

—Patient avoids the psychological burden of having mastectomy deformities.

—Costs less since fewer operations are required instead of staged procedures.

Disadvantage

—Potential delay of adjuvant therapy due to surgical complications, partial necrosis of mastectomy flaps and possibility of an unanticipated post op radiotherapy requirement

TIMING of breast reconstruction: —   Delayed reconstruction initiated at least 3-6 months after mastectomy. Advantage
TIMING of breast reconstruction:
TIMING of breast reconstruction:

—Delayed reconstruction initiated at least 3-6 months after mastectomy.

Advantage

—Avoids mastectomy flap unreliability and radiotherapy unpredictability.

Disadvantage

—Patient is subjected to additional operative procedure and overall cosmetic result is often worse.

Partial breast reconstruction
Partial breast
reconstruction

—Over the last decade, many women have chosen BCT-breast conservation therapy (consisting of segmental

mastectomy with sentinel lymph node biopsy and/or axillary lymph node dissection combined with post-op whole breast irradiation).

—Though this less invasive treatment is beneficial to many women, significant breast deformity can result from tissue removal and radiation-induced changes, especially in women with small breasts.

Oncoplastic surgery
Oncoplastic surgery

—Refers to the set of techniques developed to lessen breast deformity from segmental mastectomy, in delayed or immediate settings.

—A drawback of oncoplastic techniques when performed at the time of segmental mastectomy is the chance that if the specimen margins are not clear, reconstruction must be taken down to allow for reexcision.

—Another shortcoming is the potential for fat necrosis, especially distally, in nonaxial pattern flaps.

Reference —   Schwartz, S. I., Brunicardi, F. C., Andersen, D. K., Billiar, T. R., Dunn,
Reference
Reference

—Schwartz, S. I., Brunicardi, F. C., Andersen,

D. K., Billiar, T. R., Dunn, D. L., Hunter, J.

G.,

. . .

Pollock, R. E. (2014). Schwartz's

principles of surgery. New York: McGraw- Hill Education.