title: Breast reconstruction without implant: experience of 52 cases.
abstract: Reconstruction of the breast (BR) after mastectomy without using a prosthetic implant has always presented a challenge for plastic surgeons, allowing them to avoid complications due to foreign body and to provide a more natural reconstructed breast. Out of 66 women who underwent BR using the rectus abdominis musculocutaneous flap, 52 received no implant. Ten upper rectus (ERF) and 42 lower rectus (TRAM) were the two procedures applied. The ERF has been abandoned due to the 9% rate of complete necrosis encountered among the total series of rectus flap regardless of the implant inclusion. Partial necrosis was also the most frequent complication of the TRAM (28% among those not having received an implant), but the reconstruction was nevertheless possible in all the cases. The TRAM technique produced abdominal sequelae in 45% of the no-implant cases, though it also improved the cosmetic aspect of the abdomen in an equal number of cases, particularly in obese women. Overall cosmetic results were also better for the TRAM without implant than for the ERF (72% good vs. 51%). Moreover the BR without implant could be performed in only 48% of the total ERF, as compared to 93% of the total TRAM. The major advantage of such BR without implant is that it provides a reconstructed breast which appears more symmetrical to the contralateral breast and which remains even after several years of follow-up.
mesh_terms: D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000534:rehabilitation*; D019736:Prostheses and Implants; D013524:Surgical Flaps