Timing and selection of methods for breast reconstruction

According to the existing large-sample retrospective studies, breast reconstruction does not affect the treatment effect of breast cancer and the cure rate and survival rate of patients. In other words, except for some patients with poor physical conditions or poor tumor prognosis, most breast cancer patients can undergo breast reconstruction. In terms of operation time, breast reconstruction can be categorized into immediate reconstruction and delayed reconstruction. Immediate reconstruction refers to reconstructive surgery performed at the same time as radical mastectomy. Its advantages are firstly, one surgery solves two problems, avoiding the trouble of two hospitalizations, anesthesia and surgery, convenient and low cost. Second: Patients do not have to go through the psychological trauma caused by breast mutilation. Third: Because reconstruction is performed immediately after mastectomy, many anatomical structures are preserved and the reconstructed breast is more realistic and effective. However, there are disadvantages to immediate reconstruction. First, it requires collaboration between breast surgery and plastic surgery, so not all hospitals are able to perform immediate reconstruction. Second: Breast reconstruction may interfere with post-operative radiotherapy for breast cancer. Third: If radiation therapy is required, the reconstructed breast may suffer radiation damage caused by radiation therapy. Delayed reconstruction refers to breast reconstruction after radical mastectomy, after a period of radiotherapy and chemotherapy, and after the condition is stabilized. Its biggest advantage is that it will not interfere with the radiotherapy for breast cancer and the reconstructed breast will not be affected by the radiotherapy. Breast reconstruction can be categorized into prosthesis reconstruction and autologous tissue reconstruction in terms of the materials used. Breast implant reconstruction is a reconstruction that is filled with silicone gel implants, using the same implants used for breast augmentation. Advantages: simple process, short time, low cost in the near future. However, its biggest disadvantage is the contracture of the envelope. The peritoneum is a layer of scar tissue that wraps around the prosthesis produced by the contact between the prosthesis and the body, and peritoneal contracture is formed after contracture of this layer of scar in some patients. Mild contracture of the envelope will cause deformation of the breast, and severe contracture of the envelope will make the breast hard and painful. As the soft tissue on the surface of breast cancer patients is thinner than that of breast augmentation patients, the incidence of periosteoconstriction is much higher than that of breast augmentation patients, which can reach about 40%. Normal breasts change with the body’s age and weight, while implant reconstruction basically does not change, so when the healthy side of the breast changes need to be surgically adjusted to ensure the symmetry of both sides. There are some other disadvantages of implant reconstruction such as pain, infection and leakage of implant. Therefore, implant reconstruction is only suitable for a small number of patients. Another type of reconstruction using one’s own tissues is called autologous tissue reconstruction, which is a method of transplanting one’s own fat, muscle, and other tissues from other places to the breasts for breast reconstruction. The biggest advantage of autologous tissue reconstruction is its realism. The main component of autologous breasts is fat, just like normal breasts, so they are softer and have good mobility like normal breasts. They change with age and weight, and after one year, there is no need for another surgery to adjust the symmetry of the two breasts. Autologous tissue reconstructed breasts are more conducive to the growth of nerves, so the recovery of sensation in the reconstructed breasts is better than in breasts reconstructed with implants. The biggest disadvantage of breast reconstruction using autologous tissue is that it involves tissue grafting, which makes the surgery complex, long and requires certain surgical hardware and software. The best timing and method of breast reconstruction is the one that is most suitable for the patient. It is the one that is chosen by the patient according to the patient’s specific situation, in close collaboration with breast surgeons, radiologists and plastic surgeons, and after full communication with the patient.