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Pr os pect s of brea st

re con stru ct ion in LA BC


DR. PAW AN AGAR WA L
MS,M Ch ,DNB,MN AMS (P LAS TIC SURG ERY)
Ass ociate Prof ess or
NSCB Govern ment Med ical Col leg e Ja balpur
Breast cancer is a bio-
psycho-social disease
Breast reconstruction is a
functional procedure
Almost all women today are likely to
be candidates either for breast
preservation or for reconstruction, if
mastectomy is the elected or
required surgery
Age and stage of disease no longer
the major contraindications for this
procedure
Should we do it ?
When to do it ?
Ti mi ng f or br east
rec onstruct ion

Immediate is preferred
Adv antages of immed iat e
recon stru ct ion

1. Economy
2. Psychology
3. Total breast cancer care
4. Relation with Gen. Surgeons
5. Aesthetic considerations
In dic ation s for d elay ed
recon stru ct ion
1. Patient’s preference
2. Oncologic surgeon’s preference
3. Postoperative RT needed
4. Medically and psychologically unfit
5. Doubt about the viability of mastectomy
skin flaps
Goa ls of b rea st
recon stru ct ion

1. Relief from negative feelings


2. Symmetry with contra lateral breast
3. Forgetting about mastectomy
4. Emotional recovery
Ch oice of t ech niq ue

1. Sub muscular silicon Implants


2. Soft tissue expansion with implants
3. The TRAM flap
4. Lat. Dorsi musculo cutaneous flap
5. Less commonly Free tissue transfer
My ths for IB R in L AB C

• Oncological safety of the procedure


• Delay in postoperative CT
• Interference with adjuvant CT
• Oncological efficacy of RT and its effect on
reconstructed breast
• Seeding of tumor through out chest and
donor site
Tru ths a bou t b rea st
recon stru ct ion
1. Equal local or distant failure rates compared
to historic controls
2. Postoperative wound complications fairly
consistent (approximately 14%)
3. Does not interfere with chemotherapy or
radiation treatment
Con clu sion s
IBR can be performed with low morbidity
in patients with LABC

IBR is associated with somewhat longer


intervals to resumption of postoperative
chemotherapy, but this does not appear
to be clinically significant
Con clu sion s
Use of autogenous tissue is preferable
because of poor results with implants

The local and distant relapse rates are


similar for LABC patients undergoing
MRM with or without IBR.
Neither breast conservation surgery
nor breast reconstruction is a
procedure without complications, but
the benefits tend to be impressive
especially when carefully considered