Primary versus Secondary Postmastectomy Reconstruction

Abstract

Many patients who undergo a mastectomy desire breast reconstruction. The reconstructive surgeon must ensure that the patient has reasonable expectations and motives. While immediate breast reconstruction generally results in a more aesthetically pleasing breast, the primary consideration is treating the cancer. Immediate breast reconstruction has not been shown to affect the oncologic outcome; however, the reconstructive surgeon should confer with other treatment team members to obtain a clear understanding of the stage of cancer and any necessary adjuvant treatments. The likelihood of tumor recurrence, extent of excision required, and need for postoperative radiation, as well as psychosocial and financial considerations, may affect whether immediate or delayed reconstruction is appropriate.

Zusammenfassung

Viele Patientinnen, bei denen eine Mastektomie erforderlich ist, wünschen sich heutzutage die Rekonstruktion der Brust. Aufgabe des rekonstruktiven plastischen Chirurgen ist es, sicherzustellen, dass die Patientinnen eine realistische Erwartungshaltung haben. Obwohl die Sofortrekonstruktion meist ein ästhetisch günstigeres Ergebnis liefert, bleibt die ärztliche Hauptaufgabe die onkologische Behandlung des Mammakarzinoms. Die Durchführung einer Sofortrekonstruktion hat bisher keinen Einfluss auf das onkologische Ergebnis gezeigt. Dennoch sollte der rekonstruktive plastische Chirurg im Rahmen der interdisziplinären Zusammenarbeit mit dem gesamten Behandlungsteam das Ausmaß der Tumorerkrankung und der notwendigen adjuvanten Therapiemaßnahmen für die Patientin definieren. Die Wahrscheinlichkeit eines Tumorrezidivs, das Ausmaß der nötigen Tumorresektion, eine postoperative Bestrahlung sowie psychosoziale und finanzielle Aspekte können die Entscheidung zur Sofortrekonstruktion oder alternativ zur sekundären Rekonstruktion nach Mastektomie beeinflussen.

breast surgery - breast reconstruction - microsurgery - free flaps

Brustchirurgie - Mammarekonstruktion - Mikrochirurgie - freie Lappenplastiken

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