title: Update on breast reconstruction techniques and indications.
abstract: Breast reconstruction is considered as part of the breast cancer treatment when a mastectomy is required. Implants or expanders are the most frequent techniques used for the reconstructions. Expander provides usually a better symmetry. A contralateral mastoplasty often is required to improve the symmetry. The nipple areola complex, which can be preserved in certain conditions, is usually removed and can be reconstructed in a second stage under local anesthesia. In case of radical mastectomy and/or radiotherapy, a musculocutaneous flap, such as rectus abdominis or latissimus dorsi autologous flaps, is required. When microsurgical facilities are available, free or perforator flaps respecting the muscle are preferred to decrease the donor site complications. In situ carcinomas or prophylactic mastectomy can be reconstructed immediately as well as invasive carcinoma according to the recent literature. Locally advanced breast cancer can be reconstructed after complete oncologic treatment. Radiotherapy of the thoracic wall is proposed in case of lymph node metastases, raising the discussion about the technique choice and the timing of the reconstruction. Plastic surgery procedures can improve the cosmetic results of the conservative surgery, also extending its indications and reducing both mastectomy and reexcision rates. Oncoplasty techniques are becoming more and more sophisticated, requiring the skill of trained plastic surgeons. Numerous publications confirm the psychosocial benefit resulting from the breast reconstruction.
authors.affiliation: European Institute of Oncology-EIO, Plastic and Reconstructive Surgery Unit, Via Ripamonti, 435, 20.141, Milan, Italy. jean.petit@ieo.it
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Petit
authors.forename: Mario
authors.initials: M
authors.lastname: Rietjens
authors.forename: Visnu
authors.initials: V
authors.lastname: Lohsiriwat
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Rey
authors.forename: Cristina
authors.initials: C
authors.lastname: Garusi
authors.forename: Francesca
authors.initials: F
authors.lastname: De Lorenzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Martella
authors.forename: Andrea
authors.initials: A
authors.lastname: Manconi
authors.forename: Benedetta
authors.initials: B
authors.lastname: Barbieri
authors.forename: Krishna B
authors.initials: KB
authors.lastname: Clough
mesh_terms: D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D003286:Contracture / Q000209:etiology; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D009558:Nipples / Q000601:surgery; D011183:Postoperative Complications; D013524:Surgical Flaps; D015625:Tissue Expansion Devices