Breast cancer is the most common malignant neoplasm in women. The
effective screening process, associated with new treatment
modalities have significantly improved the ability to remove and
control the disease, and subsequent cure.
Almost all women after mastectomy (breast removal) are candidates for some kind of reconstruction, whether immediate or deferred.
The breast reconstruction can be performed in two ways: using prosthetic materials or the patient's own tissues (autologous). The techniques vary from patient to patient depending on the condition of the remaining tissues, availability of donor areas, anticipation of the need for radiation, the patient's own will, and surgeon's preference.
Various techniques are available, including:
- Reconstruction with expanders/prosthesis: usually with faster recovery, good results in bilateral cases, worst in unilateral cases, as they may lead to asymmetry relative to the contralateral breast; high risk of complications in the case of needing adjuvant radiotherapy.
- Lipofilling/transfer of fat grafts: in our opinion ideal to complement other reconstruction techniques or lumpectomy/quadrantectomy defects (not total).
- Reconstruction with latissimus dorsi myocutaneous flap with or without associated prosthesis.
- Transverse rectus abdominis myocutaneous flap reconstruction (TRAM): transfered in a pedicled or free way; sacrifices the rectus abdominis muscle (although it may be done in a muscle-sparing form).
- Reconstruction with DIEP free flap ( deep inferior epigastric perforator flap): transfered freely, with anastomosis preferentially to the internal mammary vessels - excellent vascularization and less likelihood of fat necrosis; does not sacrifice the rectus abdominis muscle - lower incidence of abdominal deformity; it is currently considered the gold standard technique for autologous breast reconstruction.
- Other free flaps (TAP, S-GAP, TUG, SIEA)