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Simultaneous reconstructive surgery for radical mastectomy

DOI: 10.1186/bcr1214

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Abstract:

The increased use of postmastectomy radiation therapy in patients with early-stage breast cancer has increased the complexity of planning for immediate breast reconstruction. Studies have evaluated the outcomes of breast reconstruction performed before radiation therapy, revealing a high incidence of complications and poor aesthetic outcomes [3]. Moreover, immediate breast reconstruction can interfere with the delivery of postmastectomy radiation therapy. Multidisciplinary breast conference identification of early breast cancer patients at high risk for radiation therapy has evolved a unique and highly successful 'delayed immediate' reconstruction [4] approach that preserves the aesthetic outcomes of immediate reconstruction and avoids radiation injury to the reconstructive tissues. This is accomplished by utilizing a filled subpectoral tissue expander to temporarily preserve the breast skin envelope until the final tissue pathology is confirmed and the patient either goes on to definitive reconstruction or to radiation therapy with the expander deflated. A total of 28 high-risk early breast cancer patients have undergone the delayed immediate approach with 20 patients (71%) not ultimately requiring radiation therapy. Nineteen patients in the non-radiated group (95%) have now completed definitive reconstruction, primarily with the use of autologous tissues. The eight patients who required radiation have completed the radiation therapy and six (75%) have undergone tissue re-expansion and skin-preserving delayed reconstruction designed to be as similar in outcome to immediate reconstruction as possible. The complication rate for the initial expander placement at the time of mastectomy was 18% for all patients. Five nonradiated patients (25%) had complications in the second stage of definitive reconstruction and one patient (17%) following radiation therapy had complications in the skin-preserving delayed reconstruction.Finally, following the successful experience of t

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