Reconstructive surgery in operable breast cancer. Critical evaluation.

In a large number of patients suffering from breast carcinoma the surgeon is still forced, for strictly technical reasons and/or by the patient's choice, to perform a radical operation that psychologically and practically compromises the quality of life of the patient, in varying degrees from patient to patient. The authors have analyzed the main characteristics of BR from the esthetic-functional, psychological, and oncological points of view, in the light of a careful examination of the literature and of the data relating to a sample group of 500 BR treated according to a protocol in which BR has been included, with times and modalities depending on the histological type of tumor and the level of local evolution of the disease. The variety of BR techniques available is such as to permit this option in a great variety of cases. Whenever possible, immediate BR, with placement of a breast prosthesis at the same time or after positioning a tissue expander, is to be preferred. If additional skin or muscle is needed, BR is to be performed at a later time by means of more complex techniques (latissimus dorsi myocutaneous flap plus prosthesis, TRAM flap, free flap). When performed after adequate evaluation and in a technically valid way, BR gives good esthetic and psychological results, has a low incidence of complications or sequelae, and does not affect the natural history of the disease; in particular, BR does not change the percentage of local recurrence or its early diagnosis and allows adequate multidisciplinary treatment.