Immediate breast reconstruction after mastectomy for cancer

Aims: The oncological, surgical and cosmetic results, patient satisfaction and psychological morbidity of immediate breast reconstruction following mastectomy for breast cancer were evaluated. Methods: From 1980 to 1994, 79 immediate breast reconstructions were performed in Malmo. From 1985 immediate breast reconstruction was performed in 21% of mastectomies among patients less than or equal to 65 years. The most common indication for immediate reconstruction was extensive DCIS+/-multifocal invasive growth. In 61 cases permanent implants were used and in 18 expanders. The median volume in the permanent implants was 225 ml, compared with 380 ml in cases where expanders were used. Results: Post-operative complications requiring re-operation occurred in 13%. After introduction of the expander technique, no necrosis requiring explanation has occurred. OF the patients receiving radiotherapy, 71% developed capsular contracture (10/14). Four patients developed locoregional recurrence. Three-quarters of the patients had an acceptable to very satisfactory cosmetic result. Eight per cent were judged to have a Baker III-IV contracture. Of the patients, 85% were satisfied with the softness of the reconstructed breast and 76% stated the result to be in accordance with their expectations. Conclusions: We find immediate breast reconstruction after mastectomy a safe operation with results comparable to those after late reconstruction and without an increased risk of recurrence. Immediate reconstruction with an implant is not recommended in cases where radiotherapy may be necessary.