Primary versus Secondary Postmastectomy Reconstruction

Abstract

Many patients who undergo a mastectomy desire breast reconstruction. The reconstructive surgeon must ensure that the patient has reasonable expectations and motives. While immediate breast reconstruction generally results in a more aesthetically pleasing breast, the primary consideration is treating the cancer. Immediate breast reconstruction has not been shown to affect the oncologic outcome; however, the reconstructive surgeon should confer with other treatment team members to obtain a clear understanding of the stage of cancer and any necessary adjuvant treatments. The likelihood of tumor recurrence, extent of excision required, and need for postoperative radiation, as well as psychosocial and financial considerations, may affect whether immediate or delayed reconstruction is appropriate.

Zusammenfassung

Viele Patientinnen, bei denen eine Mastektomie erforderlich ist, wünschen sich heutzutage die Rekonstruktion der Brust. Aufgabe des rekonstruktiven plastischen Chirurgen ist es, sicherzustellen, dass die Patientinnen eine realistische Erwartungshaltung haben. Obwohl die Sofortrekonstruktion meist ein ästhetisch günstigeres Ergebnis liefert, bleibt die ärztliche Hauptaufgabe die onkologische Behandlung des Mammakarzinoms. Die Durchführung einer Sofortrekonstruktion hat bisher keinen Einfluss auf das onkologische Ergebnis gezeigt. Dennoch sollte der rekonstruktive plastische Chirurg im Rahmen der interdisziplinären Zusammenarbeit mit dem gesamten Behandlungsteam das Ausmaß der Tumorerkrankung und der notwendigen adjuvanten Therapiemaßnahmen für die Patientin definieren. Die Wahrscheinlichkeit eines Tumorrezidivs, das Ausmaß der nötigen Tumorresektion, eine postoperative Bestrahlung sowie psychosoziale und finanzielle Aspekte können die Entscheidung zur Sofortrekonstruktion oder alternativ zur sekundären Rekonstruktion nach Mastektomie beeinflussen.

Key words

breast surgery - breast reconstruction - microsurgery - free flaps

Schlüsselwörter

Brustchirurgie - Mammarekonstruktion - Mikrochirurgie - freie Lappenplastiken

References

• 1 Alderman A K, Kuhn L E, Lowery J C, Wilins E G. 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 7-12
• 2 Alderman A K, Wilkins E G, Lowery J C, Kim M, Davis J A. Determinants of patient satisfaction in postmastectomy breast reconstruction.  Plast Reconstr Surg. 2000;  106 769-776
• 3 Al-Ghazal S K, Sully L, Fallowfield L, Blamely R W. The psychological impact of immediate rather than delayed breast reconstruction.  Eur J Surg Onc. 2000;  26 17-19
• 4 American Cancer Society .Women's Health and Cancer Rights Act. Available at http://www.cancer.org/docroot/MIT/content/MIT_3_2X.asp Accessed January.4.2008
• 5 Barnsley G P, Grunfeld E, Coyle D, Paszat L. Surveillance mammography following the treatment of primary breast cancer with breast reconstruction: a systematic review.  Plast Reconstr Surg. 2007;  120 1125-1132
• 6 Carlson G W, Styblo T M, Lyles R. et al. . Local recurrence after skin-sparing mastectomy: tumor biology or surgical conservatism?.  Ann Surg Oncol. 2003;  10 108-112
• 7 Dean C, Chetty U, Forrest A P. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy.  Lancet. 1983;  1 459-462
• 8 Early Breast Cancer Trialists' Collaborative Group . Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials.  Lancet. 2005;  366 2087-2106
• 9 Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Holzel D. Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study.  Breast J. 2004;  10 223-231
• 10 Fajardo L L, Roberts C C, Hunt K R. Mammographic surveillance of breast cancer patients: should the mastectomy site be imaged?.  Am J Roentgenol. 1993;  161 953-955
• 11 Foster R D, Esserman L J, Anthony J P, Hwang E S, Do H. Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma.  Ann Surg Oncol. 2002;  9 820-821
• 12 Godfrey P M, Godfrey N V, Romita M C. Immediate autogenous breast reconstruction in clinically advanced disease.  Plast Reconstr Surg. 1995;  95 1039-1044
• 13 Harris J R, Halpin-Murphy P, McNeese M. et al. . Consensus statement on postmastectomy radiation therapy.  Int J Radiat Oncol Biol Phys. 1999;  5 989-990
• 14 Helvie M A, Bailey J E, Roubidoux M A. et al. . Mammographic screening of TRAM flap breast reconstructions for detection of nonpalpable recurrent cancer.  Radiology. 2002;  224 211-216
• 15 Howard M A, Polo K, Pusic A L. et al. . Breast cancer local recurrence after mastectomy and TRAM flap reconstruction: incidence and treatment options.  Plast Reconstr Surg. 2006;  117 1381-1386
• 16 Kroll S S, Khoo A, Singletary S. et al. . Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up.  Plast Reconstr Surg. 1999;  104 421-425
• 17 Kronowitz S J, Robb G L. Breast reconstruction and radiation therapy. Singletary SE, Robb GL, Hortobagyi GN, eds. Advanced therapy of breast disease. 2nd ed. London; B. C. Decker 2003: 427-438
• 18 Kronowitz S J, Hunt K K, Kuerer H M. et al. . Delayed-immediate breast reconstruction.  Plast Reconstr Surg. 2004;  113 1617-1628
• 19 Kronowitz S J, Robb G L. Breast reconstruction with postmastectomy radiation therapy: current issues.  Plast Reconstr Surg. 2004;  114 950-960
• 20 Lindbichler F, Hoflehner H, Schmidt F. et al. . Comparison of mammographic image quality in various methods of reconstructive breast surgery.  Eur Radiol. 1996;  6 925-928
• 21 Medina-Franco H, Vasconez L O, Fix R. et al. . Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer.  Ann Surg. 2002;  235 814-819
• 22 Recht A, Edge S B, Solin L J. et al. . Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology.  J Clin Oncol. 2001;  19 1539-1569
• 23 Robb G L. Immediate versus delayed breast reconstruction.  Breast Cancer Res. 2007;  9 S6-S7
• 24 Roth R S, Lowery J C, Davis J, Wilkins E G. Psychological factors predict patient satisfaction with postmastectomy breast reconstruction.  Plast Reconstr Surg. 2007;  119 2008-2015
• 25 Roth R S, Lowery J C, Davis J, Wilkins E G. Quality of life and affective distress in women seeking immediate versus delayed breast reconstruction after mastectomy for breast cancer.  Plast Reconstr Surg. 2005;  116 993-1002
• 26 Rowland J H, Desmond K A, Meyerowitz B E. et al. . Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors.  J Natl Cancer Inst. 2000;  92 1422-1429
• 27 Rowland J H, Holland J C, Chaglassian T, Kinne D. Psychological response to breast reconstruction. Expectations for and impact on postmastectomy functioning.  Psychosomatics. 1993;  34 241-250
• 28 Rubino C, Figus A, Lorettu L, Sechi G. Post-mastectomy reconstruction: a comparative analysis on psychosocial and psychopathological outcomes.  J Plast Reconstr Aesthet Surg. 2007;  60 509-518
• 29 Saulis A S, Mustoe T A, Fine N A. A retrospective analysis of patient satisfaction with immediate postmastectomy breast reconstruction: comparison of three common procedures.  Plast Reconstr Surg. 2007;  119 1669-1676
• 30 Schain W S, Wellisch D K, Pasnau R O, Landsverk J. The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstruction.  Am J Psychiat. 1985;  142 40-46
• 31 Slavin S A, Love S M, Goldwyn R M. Recurrent breast cancer following immediate reconstruction with myocutaneous flaps.  Plast Reconstr Surg. 1994;  93 1191-1204
• 32 Slavin S A, Schnitt S J, Duda R. et al. . Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer.  Plast Reconstr Surg. 1998;  102 49-62
• 33 Spear S L, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications.  Plast Reconstr Surg. 2000;  105 930-942
• 34 Spiegel A J, Butler C E. Recurrence following treatment of ductal carcinoma in situ with skin-sparing mastectomy and immediate breast reconstruction.  Plast Reconstr Surg. 2003;  111 706-711
• 35 Stevens L A, McGrath M H, Druss R G. et al. . The psychological impact of immediate breast reconstruction for women with early breast cancer.  Plast Reconstr Surg. 1984;  73 619-628
• 36 Styblo T M, Lewis M M, Carlson G. et al. . Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculocutaneous (TRAM) flap.  Ann Surg Oncol. 1996;  3 375-380
• 37 Taylor M E, Haffty B G, Shank B M. et al. . Postmastectomy radiotherapy. American College of Radiology. ACR Appropriateness criteria.  Radiology. 2000;  215 (Suppl) 1153-1170
• 38 Tran N V, Chang D W, Gupta A, Kroll S S, Robb G L. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy.  Plast Reconstr Surg. 2001;  108 78-82
• 39 Tran N V, Evans G RD, Kroll S S. et al. . Postoperative adjuvant irradiation: effects on transverse rectus abdominis muscle flap breast reconstruction.  Plast Reconstr Surg. 2000;  106 313-317
• 40 Truong P T, Olivotto I A, Whelan T J. et al. . Clinical practice guidelines for the care and treatment of breast cancer: locoregional post-mastectomy radiotherapy.  CMAJ. 2004;  170 1263-1273
• 41 Wellisch D K, Schain W S, Noone R B, Little I IIJW. Psychosocial correlates of immediate versus delayed reconstruction of the breast.  Plast Reconstr Surg. 1985;  76 713-718
• 42 Wilkins E G, Cederna P S, Lowery J C. et al. . Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study.  Plast Reconstr Surg. 2000;  106 1014-1025
• 43 Williams J K, Carlson G W, Bostwick I IIJ, Bried J T, MacKay G. The effects of radiation treatment after TRAM flap breast reconstruction.  Plast Reconstr Surg. 1997;  100 1153-1160