Determining the optimal approach to breast reconstruction after partial mastectomy.
BACKGROUND
Unfortunately, patients who desire repair of contour deformities after partial mastectomy usually present after radiation therapy, which may increase the risk of complications and result in a poor aesthetic outcome. The authors reviewed their experience with repair of partial mastectomy defects to determine the optimal approach to breast reconstruction after partial mastectomy.


METHODS
Sixty-nine patients who underwent repair of a partial mastectomy defect and received radiation therapy were included in this analysis. The reconstructive techniques were categorized as local tissue rearrangement (LTR), breast reduction, or use of a latissimus dorsi myocutaneous flap or thoracoepigastric skin flap (hereafter referred to as "flap").


RESULTS
Fifty patients underwent immediate reconstruction before radiation therapy, and 19 underwent delayed reconstruction after radiation therapy. The reconstructive techniques in patients with immediate reconstruction were local tissue rearrangement in 28 percent, breast reduction in 66 percent, and flaps in 6 percent. In patients with delayed reconstruction, 32 percent had local tissue rearrangement, 42 percent had breast reduction, and 26 percent had flaps. The complication rates for immediate and delayed reconstruction were 26 percent and 42 percent, respectively. Overall, and in the setting of immediate reconstruction, the flap technique was associated with a higher complication rate than local tissue rearrangement and breast reduction. However, in the setting of delayed reconstruction, the flap technique was associated with a lower complication rate than the other two techniques. Fifty-seven percent of the immediate reconstructions performed with the local tissue rearrangement or breast reduction technique, but only 33 percent of the immediate reconstructions performed with the flap technique, were associated with an excellent or good aesthetic outcome.


CONCLUSIONS
Immediate repair of partial mastectomy defects with local tissues results in a lower risk of complications and better aesthetic outcomes than immediate repair of partial mastectomy defects with a latissimus dorsi flap.
Kronowitz
Steven J
SJ
Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. skronowi@mdanderson.org
Feledy
Jules A
JA
Hunt
Kelly K
KK
Kuerer
Henry M
HM
Youssef
Adel
A
Koutz
Cindy A
CA
Robb
Geoffrey L
GL
D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D044584:Carcinoma, Ductal / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011879:Radiotherapy Dosage; D013524:Surgical Flaps; D013997:Time Factors