Breast reconstruction after mastectomy.

The goal of breast reconstruction is to reconstruct breasts which meet the patient's expectations both psychologically and aesthetically, while adhering to the principles of sound oncological management. Breast reconstruction is usually started around 3 to 9 mos after mastectomy. The simplest method of reconstruction uses tissue available after mastectomy and a silicone implant. The recent advances with tissue expansion of the skin of the mastectomy site can permit reconstruction without the use of a flap. The latissimus dorsi flap from the back is a useful source of muscle and skin and the transverse rectus abdominus musculocutaneous flap provides tissue from the lower abdomen enabling breast reconstruction without the use of a silicone implant. Fat and skin from the buttocks may be used in a microsurgical transfer technique. Prophylactic mastectomy and immediate breast reconstruction are still controversial, but are options for the woman who is worried about the development of breast cancer. The reconstruction of the nipple and areola is only done after reconstructed breast symmetry is ascertained.