Breast reconstruction after mastectomy

The management of the woman with breast cancer who requires mastectomy should involve a multidisciplinary approach which includes close collaboration between the oncological surgeon, the medical oncologist, the radiation oncologist and the reconstructive surgeon. The reconstructive surgeon can be a useful source of information for the patient with respect to the available options for breast reconstruction as well as appropriate techniques and timing. Current evidence supports the use of immediate breast reconstruction which can be performed either by specialist breast surgeons who are trained in both oncological and reconstructive surgery, or by a plastic surgeon. Advances have made reconstruction possible for almost all patients. The goals of breast reconstruction include creation of a long lasting, natural breast which meets the psychological and aesthetic needs of the patient without major morbidity at the donor site or compromise of sound oncolgic management. Autologous tissue reconstruction using the TRAM flap has become the preferred method in the USA due to the excellent results which are achieved without the need for silicone implants. Although these procedures are not without complications, careful patient selection and modifications of the technique have added to breast reconstruction safety and reliability. Current evidence supports the use of immediate breast reconstruction which can be performed either by specialist breast surgeons who are trained in both oncological and reconstructive surgery or by a plastic surgeon.