Reconstruction of the breast.

The treatment of patients with breast cancer is approached by a team preferably including the plastic surgeon. The selection of patients for reconstruction is based on the type and stage of the tumor. The usual delay is 6 month to one year after mastectomy. Skin replacement, if necessary, is done by a latissimus dorsi myocutaneous flap followed by immediate implantation of a double lumen prosthetic varying from 120 to 650 cm3. Subcutaneous implantation is avoided to diminish the risk of capsular contraction. Nipple-areola reconstruction is done in a second stage, the graft being taken either from the opposits areola or the upper inner thigh. The remaining breast is usually adapted and, in high risk patients, a prophylactic mastectomy is performed. The absent anterior axillary fold is reconstructed by the latissimus dorsi muscle attached to the pectoralis stump. Early complication rate is low, late complications include capsular contracture, displacement and exposure of the implant. Secondary corrections may be necessary to give the best possible result. In 300 cases no local recurrence has occurred after the operation, but three recurrences have been discovered at the time of reconstruction. Psychological reaction of the patients has been extremely positive.