One in eight women will develop breast cancer.
Advances in medical, surgical and radiation therapy
have increased the amount of breast-sparing procedures
available to avoid removal of the entire breast.
Nonetheless, approximately one third of breast cancer
patients will require a mastectomy due to the size of the
tumor and inability to obtain tumor free margins. Today,
reconstructive surgery makes it possible to improve the
significant defects that result from mastectomies.
The initial evaluation is primarily used to
educate the patient about reconstructive techniques.
The benefits as well as potential complications of
each procedure are discussed in detail.
Reconstructive recommendations are given based upon
the patient's desires and overall health.
Recommendations will be made for immediate
reconstruction, delayed reconstruction (a second
operation once recovery from the mastectomy is
complete), or in some cases no reconstruction at all
The patients past medical history is
thoroughly reviewed. Patients with serious
co-existing illnesses have increased potential for
complications. Conditions such as cardiac disease,
diabetes mellitus, smoking and obesity are commonly
associated with increased risk of complications.
Surgical histories are obtained to evaluate how
previous surgeries may effect reconstructive options.
A prior abdominoplasty or upper abdominal scar may
eliminate the possibility of a pedicled transverse
rectus abdominus myocutaneous (TRAM) flap. Lower
abdominal scars may signify injury to perforators or
pedicles supplying the tissue utilized for breast
reconstruction. However c-section (lower mid-line or
transverse) incisions usually do not eliminate the
use of the TRAM flap.
If radiation therapy is being considered, patients
are strongly advised against expander/implant
reconstruction due to the higher incidence of
symptomatic capsular contraction (hardening of the
breast mound) and difficulties with expansion of
One of the most difficult challenges of breast
reconstruction is to achieve symmetry between the
native breast and the reconstructed breast. Before
selecting a reconstructive approach, breast symmetry
is discussed in relation to the remaining breast.
There is a possibility the reconstructed breast may
not be able to match the remaining breast. If the
remaining breast is larger or ptotic, reduction
mammoplasty or mastopexy may be considered. If the
remaining breast is small, consideration may be given
to augmentation to achieve symmetry with the