Education And Debate


BMJ 1995; 310 doi: (Published 14 January 1995) Cite this as: BMJ 1995;310:117
  1. J D Watson,
  2. J R C Sainsbury,
  3. J M Dixon

    The purpose of the operation is to reconstruct a breast mound to produce breast symmetry. In centres that provide reconstruction there has been a consistent increase in demand, and up to half of patients offered immediate breast reconstruction take up this offer. There is no evidence that immediate reconstruction increases the rate of local or systemic relapse, and it reduces the psychological trauma of the change in body image experienced after mastectomy. Breast reconstruction (particularly immediate reconstruction, which gives substantially better cosmetic and psychological outcomes) should be more widely available than it is at present.

    Number of breast reconstructions performed each year for past decade in Edinburgh Breast Unit.

    Treatment options

    The choice of operation for an individual patient depends on severalfactors. Immediate breast reconstruction is less time consuming for the patient (though not for the surgeon), but care must be taken that an oncological operation is not jeopardised for a better cosmetic result. Reconstruction can be carried out by immediate placement of a prosthesis (implant), insertion of a tissue expander, or insertion of a flap of skin and muscle (myocutaneous flap) with or without a prosthesis.

    View this table:

    Options for breast reconstruction

    Implants and expanders are usually inserted under the chest wall muscles (the pectoralis major and parts of the serratus anterior and rectus abdominis); the expander is inflated over a period of months to stretch the skin and muscle and is eventually replaced with a prosthesis. The two most common myocutaneous flaps used require movement of either the latissimus dorsi muscle with overlying skin or the lower abdominal fat and skin based on the rectus abdominus muscle (transverse rectusabdominus myocutaneous (TRAM) flap). Latissimus flaps usually require a prosthesis to be placed between them and the chest wall to create a breast mound. TRAM flaps—which can be performed as a pedicled flap based …

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