Immediate postmastectomy reconstruction.

The role of reconstruction in the management of patients with problems related to breast cancer is of increasing importance. Immediate reconstruction is particularly applicable in those situations where prophylactic mastectomy is performed. High-risk groups who warrant such prophylactic mastectomy and reconstruction include those with florid cyst disease, a strong family history of breast cancer, the finding of lobular carcinoma in situ, multiple previous biopsies, and those who have severe and progressive mastodynia. In those with smaller amounts of breast tissue, reconstruction is based on a double layer tissue over a graft, one layer consisting of pectoral muscle and the other of breast skin. In those with more abundant breast tissue, the two layers placed over the graft are both derived from skin flaps, the inner layer a free, denuded dermal graft from the inferior flap and the second layer, the superior breast skin flap itself.