Cosmetic results of immediate breast reconstruction post-mastectomy: a follow-up study.

We reviewed 95 patients who underwent immediate breast reconstruction at the time of mastectomy at least one year after operation for assessment of cosmetic results and complications. There were 45 rectus abdominis and 38 latissimus dorsi myocutaneous flaps used for reconstruction. Twelve patients had subpectoral implants without a flap. The results show a remarkable concordance of assessment by patient and surgeon: both found simple subpectoral prosthesis insertion to be inferior to flap reconstruction. Flap reconstruction gave satisfactory results in the majority of patients; latissimus dorsi and rectus abdominis flaps gave similar cosmetic results. However rectus abdominis flaps showed a higher complication rate of flap necrosis and incisional hernia of the abdominal wound. Psychological assessment showed no differences between the three types of reconstruction. We conclude that immediate breast reconstruction can give excellent cosmetic results, and provides an acceptable and safe means of ameliorating the effects of mastectomy. The number of grossly unsatisfactory results decreased notably as the series progressed. Experience and meticulous attention to detail are necessary, since many patients are unwilling to have revisionary procedures if the initial result is unsatisfactory.