Surgical treatment of women with breast cancer includes procedures within mammary gland and surrounding lymph nodes. Nowadays the most common are treatments saving the mammary gland in combination with so called biopsy of sentinel nodes. In most cases we are forced to perform mastectomy usually due to the primary clinical stage of the disease or in case of carrier state genetic mutations predisposing the development of breast cancer. The loss of breast, one of the most important attribute of femininity is always a traumatic experience. That is why surgical oncology and plastic surgery have developed various methods of breast reconstruction that can be performed in most patients qualified to mastectomy. The reconstruction procedures can be divided into one step treatment, performed immediately after mastectomy during one anesthesia and postponed which are performed after some time from the first ablation procedure.
Breast reconstructions performed with the use of the patient’s own tissues are called autologous reconstructions. Such procedures involve the reconstruction of the mammary gland from the dermal-adipose flaps, which can be pedunculated or transplanted using microsurgical techniques. The most common techniques for autologous reconstructions include: pedunculated or free TRAM flap (on the abdominal muscle), free DIEP flap (using inferior epigastric vessels), pedunculated LD flap (on the widest muscle of the back).
Reconstructions using silicone implants are the alternative to the autologous procedures. These may be postponed reconstructions, typically two step treatments using so called expander prosthesis which are then replaced with the silicone definitive prosthesis. Recently we have been observing the fast development of one step treatment during which we implant silicone definitive prosthesis directly after mastectomy.
In several cases autologous reconstructions may be joined with the implantation of silicone implants e.g. in patients after radiotherapy (LD flap + definitive prosthesis).
On the other hand the procedures of the adipose tissue transfer are performed mainly to improve the cosmetic effect after the other reconstructive surgeries or save the mammary gland.