Breast Reconstruction

ABSTRACT

Breast cancer is one of the most common diseases treated by general and plastic surgeons. Reconstruction of the breast began in the 1960s with the invention of the silicone breast implant. Since then, breast reconstruction has undergone an evolution. It is possible to add a woman's own tissue to enhance an implant reconstruction, as in the latissimus dorsi myocutaneous flap, but often autologous tissue alone is sufficient to create a breast. Initially this was performed using abdominal tissue based on one of the rectus abdominis muscles and the superior epigastric system known as the TRAM (transverse rectus abdominis myocutaneous) flap. Now the same tissue is often transplanted as a free tissue transfer based on the deep inferior epigastric vessels. Strides have been made to lessen the morbidity on the abdominal wall with muscle-preserving operations to include the muscle-sparing TRAM, deep inferior epigastric perforator (DIEP) flap, and superficial inferior epigastric artery (SIEA) flaps. Similarly, in certain situations, gluteal tissue and inner thigh skin and fat can be used to reconstruct a breast, superior and inferior gluteal artery (SGAP/IGAP) flap and transverse upper gracilis (TUG) flaps respectively. The complications of each of these forms of breast reconstruction are reviewed as well. Breast reconstruction often now includes surgery to the noncancerous breast as well, as prophylactic mastectomy is becoming a more popular choice for women. In addition, the effects of radiation in breast conservation therapy are becoming evident and strides are being made to improve cosmetic outcome through breast rearrangement and reduction strategies. Through an alliance among the general and reconstructive surgeons, women ’ s breast cancer needs can be addressed in an individualized manner.