Immediate breast reconstruction after mastectomy for cancer

Aims: The oncological, surgical and cosmetic results, patient satisfaction and psychological morbidity of immediate breast reconstruction following ma stectomy for breast cancer were evaluated. Methods: From 1980 to 1994, 79 immediate breast reconstructions were perfor med in Malmo. From 1985 immediate breast reconstruction was performed in 21 % of mastectomies among patients less than or equal to 65 years. The most c ommon indication for immediate reconstruction was extensive DCIS+/-multifoc al invasive growth. In 61 cases permanent implants were used and in 18 expa nders. The median volume in the permanent implants was 225 ml, compared wit h 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 expl anation has occurred. OF the patients receiving radiotherapy, 71% developed capsular contracture (10/14). Four patients developed locoregional recurre nce. Three-quarters of the patients had an acceptable to very satisfactory cosmetic result. Eight per cent were judged to have a Baker III-IV contract ure. Of the patients, 85% were satisfied with the softness of the reconstru cted breast and 76% stated the result to be in accordance with their expect ations. Conclusions: We find immediate breast reconstruction after mastectomy a saf e operation with results comparable to those after late reconstruction and without an increased risk of recurrence. Immediate reconstruction with an i mplant is not recommended in cases where radiotherapy may be necessary.