Breast Reconstruction following Mastectomy: Indications, Techniques

p2990 Breast cancer affects more than 1 of every 10 women in the United States, requiring large numbers of women to undergo breast surgery. Many women who are appropriate candidates will choose to undergo breast-conserving therapy (BCT), comprising lumpectomy with postoperative radiation, which has been shown to have equivalent survival rates to the more disfiguring mastectomy. However, certain absolute and relative contraindications to BCT exist, making approximately 25% of patients with stage I or II disease medically more appropriate for mastectomies. More severe cancers are also more appropriately managed with mastectomies. Additionally, approximately 20% of patients who are candidates for BCT opt for mastectomy on the basis of personal choice. Furthermore, some women with a strong family history of malignancies including maternal lineage breast cancer are considered at high risk for developing breast cancer. They may chose to undergo genetic testing for BRCA1 or BRCA2 mutation as well. Many of these patients select bilateral prophylactic mastectomy with reconstruction and oophorectomy. Some patients choose to have no breast reconstruction, whereas others choose either immediate or delayed reconstructions. Overall, close to 75,000 women undergo breast reconstruction each year. p3000 Women undergoing immediate or early reconstructions comprise less than 20% of mastectomy patients. However, this number is on the rise, partially as a result of the Women’s Health and Cancer Rights Act of 1998, which mandates that medical insurance companies cover the costs associated with reconstruction of the affected breast, as well as procedures to the contralateral breast to enhance symmetry. As more women undergo mastectomies and seek reconstructions, the reconstructive options available have expanded. Patients currently may choose between reconstruction with implants of several varieties and reconstruction with autologous tissue from the back, buttocks, or abdomen, either as pedicled flaps to preserve blood supply or as free tissue transfers.