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Review
. 2015 Aug 31;112(35-36):593-600.
doi: 10.3238/arztebl.2015.0593.

Breast Reconstruction Following Cancer Treatment

Bernd Gerber  1 , Mario Marx, Michael Untch, Andree Faridi
Affiliations
Review

Breast Reconstruction Following Cancer Treatment

Bernd Gerber et al. Dtsch Arztebl Int. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Dtsch Arztebl Int. 2016 Apr 22;113(16):286. Dtsch Arztebl Int. 2016. PMID: 27159143 Free PMC article. No abstract available.

Abstract

Background: About 8000 breast reconstructions after mastectomy are performed in Germany each year. It has become more difficult to advise patients because of the wide variety of heterologous and autologous techniques that are now available and because of changes in the recommendations about radiotherapy.

Methods: This article is based on a review of pertinent articles (2005-2014) that were retrieved by a selective search employing the search terms "mastectomy" and "breast reconstruction."

Results: The goal of reconstruction is to achieve an oncologically safe and aestically satisfactory result for the patient over the long term. Heterologous, i.e., implant-based, breast reconstruction (IBR) and autologous breast reconstruction (ABR) are complementary techniques. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. If post-mastectomy radiotherapy (PMRT) is not indicated, implant-based reconstruction with or without a net/acellular dermal matrix (ADM) is a common option. Complications such as seroma formation, infection, and explantation are significantly more common when an ADM is used (15.3% vs. 5.4% ). If PMRT is performed, then the complication rate of implant-based breast reconstruction is 1 to 48% ; in particular, Baker grade III/IV capsular fibrosis occurs in 7 to 22% of patients, and the prosthesis must be explanted in 9 to 41% . Primary or, preferably, secondary autologous reconstruction is an alternative. The results of ABR are more stable over the long term, but the operation is markedly more complex. Autologous breast reconstruction after PMRT does not increase the risk of serious complications (20.5% vs. 17.9% without radiotherapy).

Conclusion: No randomized controlled trials have yet been conducted to compare the reconstructive techniques with each other. If radiotherapy will not be performed, immediate reconstruction with an implant is recommended. On the other hand, if post-mastectomy radiotherapy is indicated, then secondary autologous breast reconstruction is the procedure of choice. Future studies should address patients' quality of life and the long-term aesthetic results after breast reconstruction.

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Figures

Figure
Figure
Procedure for breast reconstruction SSM, skin-sparing mastectomy; NSM, nipple-sparing mastectomy; MRM, modified radical hysterectomy
See this image and copyright information in PMC

Comment in

  • Treatment Quality in Breast Cancer: Numbers, Age, and Breast Reconstruction.
    Nestle-Krämling C, Andree C. Nestle-Krämling C, et al. Dtsch Arztebl Int. 2015 Aug 31;112(35-36):575-6. doi: 10.3238/arztebl.2015.0575. Dtsch Arztebl Int. 2015. PMID: 26377528 Free PMC article. No abstract available.
  • Recommendation Difficult to Understand.
    Fansa H, Heitmann C. Fansa H, et al. Dtsch Arztebl Int. 2016 Apr 15;113(15):269. doi: 10.3238/arztebl.2016.0269a. Dtsch Arztebl Int. 2016. PMID: 27151465 Free PMC article. No abstract available.
  • Subsequent Surgery to Be Expected.
    Sattler T, Sattler D. Sattler T, et al. Dtsch Arztebl Int. 2016 Apr 15;113(15):269-70. doi: 10.3238/arztebl.2016.0269b. Dtsch Arztebl Int. 2016. PMID: 27151466 Free PMC article. No abstract available.
  • In Reply.
    Gerber B, Marx M, Untch M, Faridi A. Gerber B, et al. Dtsch Arztebl Int. 2016 Apr 15;113(15):270. doi: 10.3238/arztebl.2016.0270. Dtsch Arztebl Int. 2016. PMID: 27151467 Free PMC article. No abstract available.

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