Postmastectomy reconstruction of the previously augmented breast: Diagnosis, staging, methodology, and outcome

Citation
Sl. Spear et al., Postmastectomy reconstruction of the previously augmented breast: Diagnosis, staging, methodology, and outcome, PLAS R SURG, 107(5), 2001, pp. 1167-1176
Citations number
29
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
PLASTIC AND RECONSTRUCTIVE SURGERY
ISSN journal
0032-1052 → ACNP
Volume
107
Issue
5
Year of publication
2001
Pages
1167 - 1176
Database
ISI
SICI code
0032-1052(20010415)107:5<1167:PROTPA>2.0.ZU;2-T
Abstract
Although man of the health and safety issues associated with breast augment ation have been thoroughly discussed over the past decade. the literature i s remarkably silent regarding postmastectomy reconstruction of tile prevous ly augmented breast. A retrospective review of the senior author's reconstr uctive practice was performed for the years 1983 through R larch of 1999, r evealing 21 women who underwent postmastectomy breast reconstruction after previous breast augmentation. For purposes of measuring aesthetic results, these 21 patients were matched to a carefully selected control group of 15 patients. They were also compared with other, larger populations, including 777 of the senior author's other breast reconstructions, the breast cancer registry at the Lombardi Cancer Center in Washington, D.C., and several la rge, published epidemiologic studies. The interval between the previous augmentation and the diagnosis of br east cancer ranged from 9 months to 18 years, with a mean of 9.3 years. None of the previous augmentation implants was ruptured at the time of mastectomy. Of the nine patients with previous subpectoral augmentation, cancer was de tected mammographically in five (56 percent), whereas of the 12 patients wi th previous subglandular augmentation, cancer was fir st detected mammograp hically in only three (25 percent). This difference was not statistically s ignificant (P = 0.2). Overall, eight of the study patients' tumors (38 perc ent) were first detected mammographically, which is similar to other publis hed reports of breast cancel patients in the general population. Seventy-on e percent of the 21 study patients were node-negative, which also compares favorably with other published series. Sixteen of the women with previous augmentation (76 percent) had purely pro sthetic reconstructions, Flaps were used in the other-five reconstructions (23 percent): three latissimus dorsi flaps (14 percent) and two transverse rectus abdominis musculocutaneous flaps (9 percent). All five flaps were us ed in patients who had undergone radiation therapy. Throughout tile senior author's entire reconstructive practice history transverse rectus abdominis musculocutaneous flaps were more frequently used [282 of 777 nonaugmented reconstructions (36 percent)], whereas latissimus dorsi flaps were less fre quently used [17 of 777 nonaugmented reconstructions (2.2 percent)] (p < 0. 001). The cosmetic results of the breast reconstructions in the previously augmen ted study group were generally good-re-excellent, with a mean score by blin ded observers of 3.35 of a possible 4.0. These results were comparable to o r better than those in the matched controls, who scored a mean of 9.0.