CHANGING TRENDS IN POSTMASTECTOMY BREAST RECONSTRUCTION - A 13-YEAR EXPERIENCE

Over the past two decades, significant advances have been made in the treatment of breast cancer and reconstruction following mastectomy. Th is analysis represents a 13-year review (1979-1991) of 455 postmastect omy reconstructions involving 381 patients (age range 25 to 76 years, mean 51 years). Follow-up was 6 months to 13 years (mean 5 years). Tim ing of the reconstruction, reconstructive techniques used, incidence o f complications, and final results were determined. Reconstructions we re divided into three chronologic study groups: group I, 1979-1983; gr oup II, 1984-1987; and group III, 1988-1991. A significant increase in the use of autogenous reconstruction was identified: 13 percent in gr oup I to 37 percent in group III (p < 0.0002). Complication rates were not significantly different among the three groups (p > 0.2). Signifi cant decreases in the use of implants alone and the latissimus dorsi f lap with implant were identified, while tissue expansion and TRAM flap use increased significantly (p < 0.002). Also, a significant increase in immediate reconstruction from 6 percent in group I to 28 percent i n group III occurred (p < 0.0002). There was no significant difference in complication rates between immediate and delayed reconstruction in any study group. Operative time averaged 2 hours less for nonautogeno us techniques; however, autogenous reconstruction required significant ly fewer operative revisions. The identified trends toward immediate r econstruction and use of autogenous tissue have been accomplished with out an increase in complications. Despite a decrease in overall implan t use, the textured silicone saline-filled expander/implant remains th e most frequently used device for breast reconstruction, providing a s afe and predictable method to accomplish both immediate and delayed po stmastectomy reconstruction.