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We report on 170 breasts that were reconstructed with Skin-Expander and silicone implants over a period of 15 years [1,2]. Reconstruction occurred primarily in only about one-third of the cases, since the information provided by the first doctor in charge regarding the possibilities of breast reconstruction was rather scanty. In cases treated with radiotherapy, reconstruction with Skin-Expander should not be excluded, but it is necessary to proceed with extreme caution and to give patients exact information. The complication rate is higher here than in cases which have not been exposed to radiotherapy. The final result depends directly on the primary surgery and the skin as well as the contralateral breast quality [3]. In most cases reconstruction with Skin-Expander and silicone implants meets the patients' desires: low-risk operation, fewer additional scars, and similar and improved breasts on both sides.

Five hundred ten implants were used in 273 patients. The follow-up was between 3 months and 8 years. Four hundred nineteen prostheses were used for subglandular breast augmentation, 91 for subpectoral breast reconstruction. All the breasts were checked personally: 397 augmented breasts and 86 reconstructed breasts-94.7%. The objective criterion was the Baker classification: grades I and II, good result; and grades III and IV, poor result. Results were as follows: Baker I, 397 breasts; Baker II, 78 breasts (I + II, 98.3%); Baker III, 5 breasts; Baker IV, 3 breasts (III + IV, 1.7%). Three prostheses were removed after 3, 4, and 6 years because the textured surface was totally damaged. Two bilumen prostheses lost the saline fluid. The complication rate due to the implants was very low.

A 29-year-old woman presented with an exulcerating cancer of the right breast. She underwent a total mastectomy and axillary clearance which revealed a pathological stage of T4 N+ (21/23) M0. She received chemotherapy followed by radiation therapy and by chemotherapy again. 30 months later, a contralateral breast cancer was diagnosed. A close team-work of gynaecologist, plastic surgeon, medical and radiation oncologists allowed to combine the operation with the reconstruction of both breasts together with chemotherapy and irradiation of the left chest wall (the tumor was focally infiltrating the pectoralis muscle). We would like to show that a reconstruction of the breast in a young woman presenting with a bad prognosis can be carried out provided a well-organized team-work.

How the primary surgical treatment influences the mamma reconstruction, we show on examples. If the ablatio has been made correctly, the reconstruction can be realized with a simple technique.