[Considerations in immediate and delayed breast reconstruction]

Abstract

The authors evaluate the different procedures for breast reconstruction in order to determinate the best indication of each technique. From January 1983 to June 1992, 196 reconstructions for breast cancer using implants, including 100 immediate and 96 delayed, were performed. Different types of breast implants were used in this period: in 1983-84 46 double lumen prostheses were performed, in 1985-86 34 Radovan temporary tissue expanders, from January 1986 to June 1991 115 Becker and Gibney permanent tissue expanders and 8 microstructured prostheses. Due to unavailability of silicon-gel implants, from January to June 1992 12 breast reconstructions with saline temporary tissue expanders were performed. In the patients with radical mastectomy 39 latissimus dorsi muscular flaps were carried out for implant coverage. In the same decade 204 breast reconstructions using Rectus abdominis myocutaneous (TRAM) flaps, including 201 delayed and 3 immediate were performed. It can be concluded that the implants are first choice for small or medium size breast, with light ptosis, in immediate reconstruction and when the patients refuse harder surgical procedures. On the contrary the autologous tissue, such as TRAM flap, can be used in patients with redundant abdomen, with controlateral large and ptotic breast and in delayed reconstruction.