POST-MASTECTOMY BREAST RECONSTRUCTION
JAMES ET ALll
GENERAL FACTORS IN POST-MASTECTOMY RECONSTRUCTION C. A. C. LEGGETT Brisbane
IN order to help us to keep a balanced view of this question of breast reconstruction after mastectomy, it is vital to consider the expected survival rate of patients suffering from carcinoma of the breast. The expected survival rate depends on the relation atween the essential malignancy of the carcinoma and the immune response of the patient. The expectancy for life should be considered since not many more than 50% of patients are alive after five years. Local recurrence can be shown to be a function of the clinical stage of the disease at the time of operation. The percentage of local recurrence depends on two things which can be fairly accurately assessed at thetimeof the operation.The first is the size of the tumour, measured after removal, and the second is the number of involved axillary nodes estimated on histological study. If the question of surgical reconstruction is entertained prior to mastectomy it is possible that the exent of skin sacrifice could be less than
desirable in an effort to facilitate a subsequent plastic procedure. Narrow skin margins increase the . incidence of local recurrence. It has been clearly shown that skin margins measured o n the mastectomy specimen correlate with increased local recurrence when such margins measure less than three centimetres. When the timing of a reconstruction isconsidered, it must be realized that the maximum rate of local recurrence occurs in the first three years after mastectomy. Hence if the surgeon performs a reconstruction operation within the first three years after the mastectomy, he must accept the possibility of local recurrence in the area of the reconstruction. Local recurrence i n the chest wall can be the most diabolical manifestation of breast cancer. Recently an unselected group of my mastectomy patients, questioned subsequently in regard to breast reconstruction, showed that at least 10 out of a total of 176 women were indeed interested in considering some form of breast reconstruction.
TOTAL MANAGEMENT OF THE PATIENT J. HERRON Brisbane THE most striking feature of breast cancer is the emotional aspect of the patient when she discovers the breast lump: she is not frightened - she is terrified. In a full list of modes of presentation we must note that 15% of patients present with a painful lump. There are three other significant factors in the patient’s history: (a) breast cancer in mother or AUST.N.Z. J. SURG.VOL. 49-No.
5, OCTOBER, 1979
sisters; (b) a history suggestive of fibrocystic disease; and (c) of course a previous mastectomy. If I think a breast lump is a carcinoma, I do a Trucut needle biopsy. I reserve mammography and xerography for patients with fibrocystic disease and patients in whom I feel confident that clinically the lump is benign and that a period of observation is warranted. There are, however, a number of patients 521
JAMES ET ALll
GENERAL FACTORS IN POST-MASTECTOMY RECONSTRUCTION C. A. C. LEGGETT Brisbane
IN order to help us to keep a balanced view of this question of breast reconstruction after mastectomy, it is vital to consider the expected survival rate of patients suffering from carcinoma of the breast. The expected survival rate depends on the relation atween the essential malignancy of the carcinoma and the immune response of the patient. The expectancy for life should be considered since not many more than 50% of patients are alive after five years. Local recurrence can be shown to be a function of the clinical stage of the disease at the time of operation. The percentage of local recurrence depends on two things which can be fairly accurately assessed at thetimeof the operation.The first is the size of the tumour, measured after removal, and the second is the number of involved axillary nodes estimated on histological study. If the question of surgical reconstruction is entertained prior to mastectomy it is possible that the exent of skin sacrifice could be less than
desirable in an effort to facilitate a subsequent plastic procedure. Narrow skin margins increase the . incidence of local recurrence. It has been clearly shown that skin margins measured o n the mastectomy specimen correlate with increased local recurrence when such margins measure less than three centimetres. When the timing of a reconstruction isconsidered, it must be realized that the maximum rate of local recurrence occurs in the first three years after mastectomy. Hence if the surgeon performs a reconstruction operation within the first three years after the mastectomy, he must accept the possibility of local recurrence in the area of the reconstruction. Local recurrence i n the chest wall can be the most diabolical manifestation of breast cancer. Recently an unselected group of my mastectomy patients, questioned subsequently in regard to breast reconstruction, showed that at least 10 out of a total of 176 women were indeed interested in considering some form of breast reconstruction.
TOTAL MANAGEMENT OF THE PATIENT J. HERRON Brisbane THE most striking feature of breast cancer is the emotional aspect of the patient when she discovers the breast lump: she is not frightened - she is terrified. In a full list of modes of presentation we must note that 15% of patients present with a painful lump. There are three other significant factors in the patient’s history: (a) breast cancer in mother or AUST.N.Z. J. SURG.VOL. 49-No.
5, OCTOBER, 1979
sisters; (b) a history suggestive of fibrocystic disease; and (c) of course a previous mastectomy. If I think a breast lump is a carcinoma, I do a Trucut needle biopsy. I reserve mammography and xerography for patients with fibrocystic disease and patients in whom I feel confident that clinically the lump is benign and that a period of observation is warranted. There are, however, a number of patients 521
