Safety of Immediate Breast Reconstruction

Zusammenfassung

Verglichen mit der sekundären Brustrekonstruktion, liegen die Vorteile der primären, sofortigen Brustrekonstruktion darin, dass nur eine Operation anstelle von zweien benötigt wird, zudem ist das ästhetische Ergebnis in Verbindung mit der hautsparenden Mastektomietechnik sehr gut. Die Mastektomie kann aufgrund mehrerer Indikationen erfolgen, Verringerung des Krebsrisikos bei gesunden Frauen, präinvasive, invasive Brusttumoren und Lokalrezidive. Die sofortige Rekonstruktion ist in all diesen Patientenkollektiven durchgeführt worden. Die Möglichkeit der lokalen Kontrolle ist vergleichbar mit Patientengruppen, die brusterhaltend operiert wurden oder eine Mastektomie ohne primäre Rekonstruktion erhalten haben.

Diese Übersichtsarbeit zeigt eine Zusammenfassung der vorhandenen Literatur und diskutiert die Auswahl der Patienten für eine primäre Rekonstruktion, die Verwendung der hautsparenden Mastektomie sowie die Möglichkeiten, den Mamillen-Areolen-Komplex zu erhalten. Zudem werden die Grenzen bei Verwendung von Implantaten erläutert.

Um ein individuelles Behandlungskonzept für jede Patientin mit Brustkrebs zu entwickeln, ist eine interdisziplinäre Kooperation in einem Brustzentrum notwendig. Zur Etablierung von Leitlinien für die primäre Brustrekonstruktion sollten weitere Multizenterstudien erfolgen, die eine langjährige Nachbeobachtung implizieren, die nach Patientinnen, Art des Tumors und Art der Behandlung aufgeschlüsselt sind.

Abstract

The benefits of immediate breast reconstructions (IBR) compared with late reconstructions are one operation instead of two and excellent aesthetic result with the skin-sparing mastectomy technique. Indications for mastectomy vary from risk reduction of healthy women to preinvasive, invasive and locally recurrent breast cancer. IBR has been successfully performed in all of these patient groups and local control has been comparable with the series treated with breast conservation or mastectomy without reconstruction. We review this literature and discuss patient selection, the use of skin-sparing mastectomy, possibilities of nipple conservation and limitations with the use of implants. Cooperation of multidisciplinary breast cancer teams is needed to tailor the treatment of breast cancer for each individual patient. To define guidelines for the use of IBR, multicentre studies with follow-up data of large enough series stratified by patient, tumour and treatment characteristics are needed.

Sofortige Brustrekonstruktion - hautsparende Mastektomie - lokale Kontrolle

Immediate breast reconstruction - skin-sparing mastectomy - local control

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