Over the past 40 years, surgical reconstruction of the breast following
mastectomy has become an important aspect of the
cancer patient's rehabilitation process. While the surgical emphasis remains on a cure for the
cancer, experience with
breast reconstruction has not demonstrated any increased rate of
cancer recurrence, even when reconstruction is performed immediately following
tumor resection. Advances in surgical technique and biotechnology have made post-
mastectomy reconstruction possible. The development of
silicone gel and saline-filled implants as well as
tissue expanders has revolutionized
breast reconstruction. The elucidation of
musculocutaneous flaps now provides the surgeon with the ability to transfer adequate quantities of vascularized tissue to reconstruct the surgical defects. The advent of microsurgical techniques has provided an additional reconstructive option, with free tissue transfer allowing the
plastic surgeon to move
musculocutaneous flaps from remote or distant sites to reconstruct the defect. The option of having the reconstruction immediately following the
mastectomy procedure is now available to the patient. When reviewing the anatomy of the breast region, the surgeon must consider the mammary gland, its vascular supply, and its lymphatic system. The surgical techniques involved in reconstruction after
mastectomy include the use of
breast implants and
tissue expansion, as well as reconstruction with autogenous tissues. Reconstruction with autogenous tissues includes the use of latissimus dorsi
musculocutaneous flap, transverse rectus abdominus
musculocutaneous flap,
free flap transfer, as well as nipple-areola reconstruction.
Breast reconstruction after
mastectomy should be undertaken by a
plastic and reconstructive surgeon with considerable training and experience with these diversified procedures.