BACKGROUND: Unfortunately, patients who desire repair of contour
deformities after partial
mastectomy usually present after
radiation therapy, which may increase the risk of complications and result in a poor aesthetic outcome. The authors reviewed their experience with repair of partial
mastectomy defects to determine the optimal approach to
breast reconstruction after partial
mastectomy. METHODS: Sixty-nine patients who underwent repair of a partial
mastectomy defect and received
radiation therapy were included in this analysis. The
reconstructive techniques were categorized as local tissue
rearrangement (LTR),
breast reduction, or use of a
latissimus dorsi myocutaneous flap or thoracoepigastric
skin flap (hereafter referred to as "flap"). RESULTS: Fifty patients underwent immediate reconstruction before
radiation therapy, and 19 underwent delayed reconstruction after
radiation therapy. The
reconstructive techniques in patients with immediate reconstruction were local tissue
rearrangement in 28 percent,
breast reduction in 66 percent, and flaps in 6 percent. In patients with delayed reconstruction, 32 percent had local tissue
rearrangement, 42 percent had
breast reduction, and 26 percent had flaps. The complication rates for immediate and delayed reconstruction were 26 percent and 42 percent, respectively. Overall, and in the setting of immediate reconstruction, the flap technique was associated with a higher complication rate than local tissue
rearrangement and
breast reduction. However, in the setting of delayed reconstruction, the flap technique was associated with a lower complication rate than the other two techniques. Fifty-seven percent of the immediate reconstructions performed with the local tissue
rearrangement or
breast reduction technique, but only 33 percent of the immediate reconstructions performed with the flap technique, were associated with an excellent or good aesthetic outcome. CONCLUSION: Immediate repair of partial
mastectomy defects with local tissues results in a lower risk of complications and better aesthetic outcomes than immediate repair of partial
mastectomy defects with a
latissimus dorsi flap.
