Breast reconstruction may be immediate (at the same stage with mastectomy) or delayed after the completion of chemo- and/or radiotherapy. There is little evidence available from medical research to favour immediate or delayed reconstruction. Immediate reconstruction has clear psychological benefits, but patients who are expected to receive radiation therapy as part of their adjuvant treatment are usually considered for delayed reconstruction with autologous tissue (e.g. abdominal fat and skin, latissimus dorsi muscle).
The two main techniques are:
• Use of a tissue expander and silicone implant with or without use of acellular human or animal dermal graft. This is the most common method used worldwide, but is strongly contraindicated in patients who had previous radiotherapy.
• Flap reconstruction with pedicled latissimus dorsi muscle and overlying skin with silicone implant or fat following liposuction or with free abdominal wall tissue. Aesthetic result is more natural than implant alone; however, surgery and recovery period is longer. Nipple reconstruction is performed 6 months post-op under local anesthesia with a local flap (star flap) and its coloring is achieved via medical tattooing.