الفهرس 
ANATOMICAL CONSIDERATIONOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the second leading cause of cancer deaths in women and is the most common cancer among women, excluding non-melanoma skin cancers.
Techniques that are used in treatment of this disease have evolved through years to eradicate the tumor cells completely while restoring the patients’ pre-disease state. The surgical treatment of breast cancer involves either breast conserving surgery or mastectomy, both of which can result in considerable asymmetry of the breasts. Breast reconstruction offers restoration of breast symmetry to such women, achieved by creating a breast mound that is similar in size, shape, contour, and position to the opposite breast. This has led to improvement in the psychosocial well-being and quality of life in comparison with those who have mastectomy without reconstruction.
A spectrum of techniques is available from which the patient and surgeon can choose. These techniques can involve breast implants, autologous tissue, or both.
Implant based techniques are a simple and effective method of breast reconstruction, but they may not be suitable for all patients, particularly those who need or have had radiotherapy. Autologous methods in contrast are more surgically demanding, but they consistently yield better aesthetic results than non-autologous methods, particularly when combined with skin sparing mastectomy.
The options for autologous reconstruction includes (LD) flap which is technically simple yet capable of achieving excellent results. It can be used successfully in patients who have very small breasts and therefore do not require transfer of much tissue volume.
Another option is Pedicled TRAM flap breast reconstruction which remains an effective means of recreating a soft, ptotic, breast after mastectomy for patients who are in good health, do not smoke, and are not excessively obese.
More recently the development of perforator flaps has led to a great advancement in breast reconstruction by offering sufficient tissue for reconstruction with muscle spearing and minimal donor site morbidity. Many donor sites have been suggested for harvesting free flaps including the abdominal area, deep inferior epigastric perforators (DIEP) and, superficial inferior epigastric (SIEA), gluteal area, inferior gluteal artery perforator (IGAP) and, superior gluteal artery perforator (SGAP) and lower extremities, antero-lateral thigh (ALT) and, transverse upper gracilis (TUG) flaps. Donor site selection is based on the patient body morphology and the availability of sufficient tissue.
Nipple reconstruction is the perfection of breast reconstruction. Although many reconstruction techniques are available, all come with the risk of projection loss. Most of the commonly used local flap techniques give reliable immediate results, but are associated with a loss in projection of 50 to almost 70% over the first three years.