Immediate Breast Reconstruction in Carcinoma Breast – Morbidity, Technical and Psychological Issues
DOI:
https://doi.org/10.21276/d8z36n96Keywords:
Carcinoma Breast, Breast Reconstruction, Mastectomy, TRAM Flap, LD FlapAbstract
Background: Immediate breast reconstruction (IBR) in breast cancer patients is although a well accepted option but not commonly offered (in our setup). The purpose of present study was to evaluate the technique, morbidity and outcome of IBR in our institute.
Materials and methods: A prospective study with 40 patients of operable cases of carcinoma breast was done where patients undergoing modified radical mastectomy (MRM) were compared with patients undergoing MRM followed by IBR using autologous tissue. Both the groups were evaluated in terms of technical issues, morbidity and clinical outcome. The results were expressed as mean of continuous data. The psychological satisfaction in either groups was noted on body image scale
Results: In the post operative period, complication rate of 35% was noted in study group as compared to 10% in control group. Among these, the rate of seroma formation was 10%, superficial skin necrosis- 15%, total flap loss- 5%, and fat necrosis was 10%. One patient in the study had total flap loss. In study group, 95% of the patients were satisfied with the body image while 80 % of the patients undergoing MRM alone were not satisfied at all.
Conclusion: IBR is a valid option to preserve the feminity and gives a higher level of patient satisfaction than external prosthesis. It can be learnt easily and requires a change in the mindset of the surgeon to incorporate it into practice.
Downloads
References
Dixon JM, Soon PSH. Breast conserving surgery. In: Fischer JE, editor. Fifth edition, Mastery of Surgery, Vol.I. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 502-17.
Isern AE. Aesthetic outcome, patient satisfaction, and health-related quality of life in women at high risk undergoing prophylactic mastectomy and immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2008; 61: 1177-87
Malenaar S, Qort F, Spragers M. Predictors of patient’s choices for breast-conserving therapy or mastectomy: A prospective study. Br J Cancer 2004; 90: 2123-30.
Temple WJ, Russell ML, Parsons LL. Conservation surgery for breast cancer as the preferred choice: a prospective analysis. J Clin Oncol 2006; 24: 3367-73.
Delgado JF, Pedraza MJL, Blasco JA. Satisfaction with and psychological impact of immediate and deferred breast reconstruction. Annal Oncol 2008; 19: 1430-4.
Kroll SS, Coffey JA, Jr. Winn RJ. A comparison of factors affecting aesthetic outcomes of TRAM flap breast reconstruction. Plast Resconstr Surg 1995; 96: 860-5.
Rosenquist S, Sandelin K, Wickman M. Patient’s psychological and cosmetic experience after immediate breast reconstruction. Eur J Surg Oncol 1996; 22: 262-66.
Wilson Cr, Brown IM, Weiller-Mithoff. Immediate breast reconstruction does not lead to a delay in the delivery of adjuvant chemotherapy. Eur J Surg Oncol 2004; 30: 624-7.
Wilkins EG, Cederna PS, Lowery JC. Prospective analysis of psychological outcomes in breast reconstruction. One year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2000; 106: 1014-25.
Shaikh IAA, Thomas H, Vidyadharan R. Post mastectomy immediate breast reconstruction in a high volume center in India. Ind J Surg 2004; 66: 78-93
Newman LA, Kuerer HM Hunt KK. Feasibility of immediate breast reconstruction for locally advanced breast cancer. Ann Surg Oncol 1999; 6: 671-5.
Cho BCJ, McCready DR. oncologic principles in breast reconstruction. Clin Plast Surg 2007; 34: 1-13.
Schusterman MA, Kroll SS and Weldon ME. Immediate breast reconstruction: Why the free TRAM over the conventional TRAM flap? Plast Reconstr Surg, 1992, 90: 255.
Fathi M, Hatamipour E, Fathi HR. Breast reconstruction using TRAM flap: prospective outcome and complication. Med J Isla Repup Iran 2006; 20: 74-81.
Timothy JE, Louis D, Barbara LS et al. Prospective evaluation of immediate reconstruction after mastectomy. Ann Surg, 1993, 218: 29.
Pinsolle V, Grinfeder C, Mathoulin, Pelissier S. Complication analysis of 266 immediate breast reconstructions. J Plast Reconstr Aesthet Surg 2006; 59: 1017-24.
Nahabedian MY, Momen B, Manson PN. Factors associated with anastomosis failure after reconstruction of the breast. Plast Reconstr Surg 2004; 114:74-82
Ng RL, Yousaf A, Kronowiyz SJ, et al. Technical variations of bipedicled TRAM flap in unilateral breast reconstruction: effects of conventional versus microsurgical techniques of pedicle transfer on complication rates. Plast Reconstr Surg 2004; 114(2):374-83; discussion 385-8.
Temple CLF, Strom EA, Youssef AY, Langstein HN. Choices of recipient vessels in delay TRAM flap breast reconstruction after radiotherapy. Plast Reconstr Surg 2005; 115:105-13.
Trabulsy PP, Anthony JP, Mathes SJ. Changing trends in post mastectomy breast reconstruction: a 13 year experience. Plast Reconstr Surg 1994; 93(7): 1418-27.
Chang DW. Effect of obesity on flap and donor site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction [comment]. Plast Reconstr Surg 2000; 105(5): 1640-8.
Kroll SS, et al. fat necrosis in free and pedicled TRAM flaps (comment). Plast reconstr surg 1998; 102(5):1502-7.
Kroll SS, Netscher DT. Complications of TRAM flap breast reconstruction in obese patient. Plast Reconstr Surg 1989; 84(6): 886-92.
Elliot LF, et al. Immediate TRAM flap breast reconstruction: 128 consecutive cases. Plast reconstr surg 1993; 92(2):217-27.
Zertuche MD, Vidal CR. A 7 year experience with immediate breast reconstruction after skin sparing mastectomy for cancer. Eur J Surg Oncol.2007; 33:140-6.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 International Archives of BioMedical and Clinical Research (IABCR)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors are required to sign and submit the completed “Copyright transfer Form” upon acceptance of publication of the paper. This is determined by a publishing agreement between the author and International Archives of Biomedical and Clinical Research. These rights might include the right to publish, communicate and distribute online. Author(s) retain the copyright of their work. International Archives of Biomedical and Clinical Research supports the need for authors to share, disseminate and maximize the impact of their research.
