Alternatives in reconstructive surgery after mastectomy.

The modern era of breast reconstruction began about ten years ago. Today, reconstruction is possible for any woman who has had a mastectomy. The decision should be made only after discussion with both the woman's ablative surgeon and her plastic surgeon. Today there are a number of alternative methods to breast reconstruction. These include the following possibilities: immediate reconstruction, simple correction of a disturbing scar, reduction of a large remaining breast to simplify proper fitting of an external prosthesis, simple creation of a mound on the mastectomy side, insertion of a special prosthesis to fill in the subclavicular area, and reconstruction of the areolar nipple complex. Where more radical surgery has been done, the use of a myocutaneous flap, and in some special situations, reconstruction by means of microvascular anastomosis may be carried out. Some of these methods can be used in combination to fit the needs of the individual woman. It is the plastic surgeon's desire to help in the team approach in the treatment of breast cancer and by making suggestions to the ablative surgeon to make final reconstruction easier. Additional benefit might be the patients willingness to present herself earlier if she knows that in the long run reconstruction can be carried out.