Breast reconstruction: breast implants versus autologous tissue

Modified radical mastectomy remains the standard for treatment of breast ca ncer. Women faced with the diagnosis of breast cancer often find it difficu lt to cope with the arousing emotions. Fear of death or cancer recurrence a nd a perceived loss of feminity often coexists with the desire for a return to normality and wholeness. For women seeking breast reconstruction variou s techniques have been developed. Two different ways for breast reconstruction have become a standard. One wa y is the reconstruction by tissue expansion or transposing locally availabl e tissue with the use of implants. The other way is the reconstruction of t he breast without using any implants with the Latissimus dorsi flap or the TRAM flap. Methods: We performed 291 breast reconstructions. In 125 women available ti ssue and an implant was used. The Latissimus dorsi flap was used in 57 case s and 109 TRAM flaps either pedicled or as a microvascular flap were perfor med. Results: Using expanders we found a perforation of the device in 2 cases, A fter using implants there were capsular contracture in 2 cases and in 1 cas e we had an infection. Using autologous tissue we had 2 partial flap necros is, 4 hematomas, and 4 prolonged healings. There was no complete flap necro sis. Discussion: Breast reconstruction using autologous tissue i.e. the TRAM fla p is supposed to be a standard technique. Microsurgical transplantation of the TRAM flap shows almost no morbidity of the donor site area. Autologous tissue follows the changes of the body like weight gain or reduction to a c ertain extend and shows neither capsular contracture nor other implant asso ciated side effects. Women get the impression that the TRAM flap is like so ft tissue to the touch and not like a forein body. The aestethic results we re in all cases superior sometimes needing minor secondary correction and m ostly shaping of the nippel-areola complex. All patients were pleased with the result.