Pr os pect s of brea st re con stru ct ion in LA BC

DR. PAW AN AGAR WA L
MS,M Ch ,DNB,MN AMS (P LAS TIC SURG ERY)

Ass ociate Prof ess or NSCB Govern ment Med ical Col leg e Ja balpur

Breast cancer is a biopsycho-social disease

Breast reconstruction is a functional procedure

Almost all women today are likely to be candidates either for breast preservation or for reconstruction, if mastectomy is the elected or required surgery

Age and stage of disease no longer the major contraindications for this procedure

Should we do it ? When to do it ?

Ti mi ng f or br east rec onstruct ion Immediate is preferred

Adv antages of immed iat e recon stru ct ion
1. 2. 3. 4. 5. Economy Psychology Total breast cancer care Relation with Gen. Surgeons Aesthetic considerations

In dic ation s for d elay ed recon stru ct ion
1. 2. 3. 4. 5. Patient’s preference Oncologic surgeon’s preference Postoperative RT needed Medically and psychologically unfit Doubt about the viability of mastectomy skin flaps

Goa ls of b rea st recon stru ct ion
1. 2. 3. 4. Relief from negative feelings Symmetry with contra lateral breast Forgetting about mastectomy Emotional recovery

Ch oice of t ech niq ue
1. 2. 3. 4. 5. Sub muscular silicon Implants Soft tissue expansion with implants The TRAM flap Lat. Dorsi musculo cutaneous flap Less commonly Free tissue transfer

My ths for IB R in L AB C
• • • • • Oncological safety of the procedure Delay in postoperative CT Interference with adjuvant CT Oncological efficacy of RT and its effect on reconstructed breast Seeding of tumor through out chest and donor site

Tru ths a bou t b rea st recon stru ct ion
1. Equal local or distant failure rates compared to historic controls 2. Postoperative wound complications fairly consistent (approximately 14%) 3. Does not interfere with chemotherapy or radiation treatment

Con clu sion s
IBR can be performed with low morbidity in patients with LABC IBR is associated with somewhat longer intervals to resumption of postoperative chemotherapy, but this does not appear to be clinically significant

Con clu sion s
Use of autogenous tissue is preferable because of poor results with implants The local and distant relapse rates are similar for LABC patients undergoing MRM with or without IBR.

Neither breast conservation surgery nor breast reconstruction is a procedure without complications, but the benefits tend to be impressive especially when carefully considered

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