Breast reconstruction is an important aesthetic and rehabilitative option that should be offered and considered by every woman diagnosed with breast cancer. Breast reconstruction is not just for patients who are going to have a mastectomy, but may also apply to patients undergoing a lumpectomy or partial mastectomy. The number of women choosing to have breast reconstruction continues to increase on a yearly basis.1 Numerous studies have shown improved psychological well-being associated with breast reconstruction in the recovery period of women undergoing breast cancer treatment.2,3 Along with low patient morbidity, breast reconstruction has not been shown to have any deleterious effects in the overall oncologic treatment outcome.4-6 “Autologous” tissue reconstruction restores the appearance of the breast after mastectomy with the patient's own tissue. The goal of reconstructive surgery is to recreate the most natural appearance, shape, and feel of a breast. The options for breast reconstruction have dramatically increased over the past 30 years with technical advances in surgery, and physicians can now offer cosmetically acceptable breast reconstruction by using tissue from numerous areas of the body.
Microsurgery involves the use of the operating room microscope to repair blood vessels that are otherwise too small to manipulate surgically with the naked eye. Today, surgeons can transfer units of tissue from one part of the body to another to repair various physical defects and deformities. Large tissue units or “flaps” need to be perfused with blood in order to survive, such that a unit of tissue can be transferred with its associated artery and vein to a separate region of the body where the blood vessels can be reconnected (anastomosis) to local recipient blood vessels. In terms of autologous tissue breast reconstruction, physicians can utilize microsurgery to transfer skin and fat as needed to make an entire breast.
In this chapter, we discuss the clinical considerations when evaluating patients for autologous flap breast reconstruction. Please note that in practice, patients are comprehensively evaluated for their candidacy for breast reconstruction and that recommendations should be individualized such that patients consider not only autologous tissue, but also expander implant–based reconstruction. Here we limit our discussion to describing the main surgical autologous tissue flap procedures along with their indications. We hope that by the end of the chapter the reader and health care professional will have a working knowledge of the vast reconstructive armamentarium available today for breast reconstruction to be able to better counsel patients.
GOALS OF AUTOLOGOUS RECONSTRUCTION
Determining whether an implant-based or autologous reconstruction will be performed depends considerably on the patient's body habitus and desires. Many women prefer to avoid the use of implants, which are essentially mechanical devices with a limited lifespan. Instead, patients may seek to enjoy the collateral benefit of the resultant flap harvest donor area, which may produce results that are similar to cosmetic procedures, such ...