Post-mastectomy breast reconstruction

1. Paul T R Thiruchelvam, specialist registrar breast and general surgery1,
2. Fiona McNeill, consultant oncoplastic and reconstructive breast surgeon2,
3. Navid Jallali, consultant plastic and reconstructive surgeon1,
4. Paul Harris, consultant plastic and reconstructive breast surgeon2,
5. Katy Hogben, consultant oncoplastic and reconstructive breast surgeon1

Author affiliations

1. Correspondence to: P T R Thiruchelvam paul.thiruchelvam@imperial.ac.uk

• Accepted 25 September 2013

Summary points

• Breast reconstruction should be discussed with all women who undergo mastectomy
• The type of mastectomy undertaken directly influences the reconstructive outcome and aesthetics
• All reconstructive options should be discussed with the patient regardless of local expertise and appropriate referral made to specialist centres if necessary
• If radiotherapy is needed, delayed reconstruction minimises the risk of complications and improves aesthetic outcomes
• Follow-up studies show that women have a high level of satisfaction with the reconstructive option they chose, although those who opted for no reconstruction also report a high level of satisfaction

Breast cancer is the most common cancer in women, with almost 1.38 million new cases a year worldwide; it accounts for 23% of all cancers and 14% of deaths from cancer.1 However, mortality from breast cancer is declining—increasing numbers of women are long term survivors (>5 years) (currently 549 000 in the United Kingdom).2 3 Surgery remains a mainstay of treatment, either breast conservation or mastectomy, but any breast surgery can greatly alter breast aesthetics and body image.

Breast reconstruction restores breast symmetry after a mastectomy by creating a breast mound, similar in size, shape, contour, and “out of bra position” to the contralateral breast. In England and Wales in 2002, about 10% of women had immediate breast reconstruction; by 2009 this had risen to 21%.4 Post-mastectomy breast reconstruction is associated with improved body image, quality of life, self confidence, and wellbeing.5

In this review, we outline the indications for breast reconstruction along with the timing and techniques available to patients after mastectomy.

Sources and selection criteria

We searched Medline, Embase, and the Cochrane collaboration for articles using the keywords “breast reconstruction”. Wherever possible we used evidence from randomised controlled trials, systematic reviews, and meta-analyses from the past five years to provide an up to date review. We also consulted …