An objective analysis of immediate simultaneous reconstruction in the treatment of primary carcinoma of the breast.

In January 1977, the authors developed a protocol to test the advisability and feasibility of immediate simultaneous reconstruction in the treatment of primary carcinoma of the breast. Initial concerns included the morbidity of the procedure, the potential for compromise of cure and of adjuvant cancer therapy, and the aesthetic acceptability of immediate reconstruction both to the patient and to the surgeon. All patients were seen preoperatively by both the oncologic surgeon (T.G.F.) and the plastic and reconstructive surgeon, (R.B.N.), and underwent modified radical mastectomy and simultaneous reconstruction. The initial protocol included only those patients with tumors 1 cm or smaller, but over the last 25 cases the protocol has been expanded to include any patient presenting with clinical Stage I carcinoma of the breast. To date, 70 such patients (ages 27-63 years) have undergone immediate simultaneous reconstruction as part of their treatment. Twenty-five patients had evidence of microscopic nodal disease (35.7%). All patients were offered adjuvant therapy, and in no case was therapy delayed beyond 4 weeks postoperatively. Three patients developed complications resulting in loss of implant (4.3%). All patients have been followed at regular intervals, and no patient has been lost to follow-up. In only one patient was there a local recurrence without distant disease. Survival curves are consistent with the stage of the disease. The surgical techniques utilized and the methods of patient selection are discussed. The authors conclude that this is a desirable and viable option in selected patients with primary breast cancer, and that immediate simultaneous reconstruction can be done with an acceptable morbidity and without compromise of cancer therapy.