Technique of Breast Reconstruction with Expander Implants after Mastectomy

The reconstruction of the female breast after mastectomy is an integral part of the surgical treatment of breast cancer nowadays. If it is necessary for oncologic reasons and if there are contraindications for breast conserving therapy, methods of breast reconstruction can contribute significantly to the restoration of physical integrity, including an improvement of life quality for the affected women. Besides an improvement or restoration of the physical image and of the self-esteem, breast reconstruction leads to a processing of an oncologically necessary mastectomy from a psychooncological and rehabilitative point of view. Alloplastic methods of breast reconstruction are the most common methods of reconstructing the female breast after mastectomy. In order to obtain optimal results from reconstruction, the use of textured, anatomically shaped expander-implant systems are recommended. After modified radical mastectomy a combined expander implant reconstruction can be indicated to reconstruct a smaller, non-ptotic breast after preforming stretching of the skin. This combined expander-implant reconstruction can be performed primarily during mastectomy as well as secondarily. If adjuvant therapy is necessary, especially in the case of radiation therapy, an implant or expander-implant reconstruction is relatively contraindicated because of an insufficiently high rate of complication. The patients need to be informed about the very often necessity of adapting mastopexy or reduction mastopexy of the contralateral breast and about possible autologous methods of reconstruction. In our opinion, adjuvant radiation therapy is a contraindication for alloplastic reconstruction because of an inacceptable complication rate, especially if compared to autologous reconstruction. Therefore, primary alloplastic reconstruction should be indicated very critically. When planning alloplastic or, of course, autologous breast reconstruction the overall oncological situation of the patient needs to be considered. To avoid prognostic or aesthetic disadvantages, the differential indication for the methods of breast reconstruction should ideally take place in specialized breast centres with experience in all methods of reconstruction.