الفهرس | Only 14 pages are availabe for public view |
Abstract Breast cancer is the second most common cancer among women and is the second leading cause of cancer deaths. The management of patients with breast cancer has evolved over the past couple of decades as a result of a better understanding of the biologic behavior of breast cancer, advances in adjuvant chemotherapy and hormonal therapy, advances in radiographic detection of early-stage breast cancer, and the implementation of breast conservation therapy and sentinel lymph node biopsy. Routine screening mammography and increased breast cancer awareness are primarily responsible for the trend towards earlier diagnosis. Although radical and modified radical mastectomies have been the mainstay treatment for early-stage breast cancer for decades, breast-conserving therapy has recently become the preferred method of treatment for appropriate patients with early-stage breast cancer. Breast reconstruction has become an integral aspect of breast cancer management. The timing of breast reconstruction after mastectomy involves many factors that are important when choosing between immediate and delayed reconstruction. Immediate reconstruction has positive psychological implications on patients by reducing the physical mutilation in oppose to delayed reconstruction. In addition, practice patterns have gradually trended towards more immediate reconstructions for non-irradiated patients owing to superior aesthetic outcomes, more facilitating recoveries, and the ability to maintain an equivalent oncologic outcome. The primary goal of breast reconstruction is to create a long lasting, naturally appearing breast after the treatment of breast cancer. This goal should be achieved with the least possible morbidity at the donor site. Recent techniques in breast reconstruction are broadly divided into autologous tissue reconstruction, non-autologous reconstruction or a combination of both. Autologous tissue breast reconstruction can generally be grouped into three main categories: local tissue rearrangement with composite breast flaps, reduction mammaplasty, and transfer of remote tissue in the form of a vascularised regional or distant flap. Nonautologous or implant- based techniquesare 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. Although autologous methods are more surgically demanding, they yield better aesthetic results than non-autologous methods.Nipple- areola complex reconstruction is an integral component of breast reconstruction which transforms the reconstructed breast mound into a more natural and pleasing breast. It is typically performed three months after the mound has been successfully reconstructed by the use of local flaps with or without skin grafts or as a composite free nipple graft from the contralateral breast. Areolar tattooing and secondary procedures to improve nipple height can also be done at a later date. Symmetry is one of the most important aims in breast reconstruction. This will further improve the overall outcome and patient satisfaction. Two types of equality must be considered: equality of volume and equality of shape. These can be achieved by either a reduction or augmentation mammaplasty procedure to the contralateral breast. Complications of breast reconstruction are not amongst patients’ expectations or in the surgeon’s interest. However, like scarring, they can occur. Minor complications can delay recovery or require further treatment and can be the cause of severe frustration for the patient and her family. The occurrence of complete failure, like total flap necrosis or the need to remove a silicon implant due to infection is relatively uncommon Various oncoplastic techniques for breast reconstruction are available, and the decision of the technique used is based on local tissue demands and the preferences of both the surgeon and the patient to achieve the best possible results. |