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Determining the Optimal Approach to Breast Reconstruction after Partial Mastectomy

Kronowitz, Steven J. M.D.; Feledy, Jules A. M.D.; Hunt, Kelly K. M.D.; Kuerer, Henry M. M.D.; Youssef, Adel M.D., Ph.D.; Koutz, Cindy A. M.S., P.A.-C.; Robb, Geoffrey L. M.D.

Plastic and Reconstructive Surgery: January 2006 - Volume 117 - Issue 1 - p 1-11
doi: 10.1097/01.prs.0000194899.01875.d6

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.

Conclusion: 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.

Houston, Texas

From the Departments of Plastic and Reconstructive Surgery and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center.

Received for publication September 30, 2004; revised February 14, 2005.

Presented at the 83rd Annual Meeting of the American Association of Plastic Surgeons, in Chicago, Illinois, May 9 to 12, 2004.

Steven J. Kronowitz, M.D., Department of Plastic Surgery, Box 443, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030,

©2006American Society of Plastic Surgeons