25.0: Thursday, March 17, 2005

Managing the Contralateral Breast in Reconstruction Patients

Robert C. Kratschmer, MD

Multiple reconstructive options are available to patients undergoing mastectomy for breast cancer. Unilateral breast reconstruction often presents a challenge to the reconstructive surgeon because of the need to create symmetry between the two breasts. We evaluated our institution's methods of managing the contralateral breast in these patients.

From January 1997 to December 2002, a retrospective analysis was performed on patients that underwent breast reconstruction for unilateral breast cancer at Christus St. Joseph. Patient demographics were recorded, as well as surgeries and timing of these procedures.

Cancer surgery procedures included simple mastectomy, skin-sparing simple mastectomy, modified radical mastectomy, and skin-sparing modified radical mastectomy. Methods of primary unilateral breast reconstruction included implant insertion, tissue expansion with secondary placement of implant, latissimus dorsi flap reconstruction , and pedicled transverse rectus abdominis myocutaneous flap reconstruction.

Procedures performed on the contralateral breast for symmetry included augmentation, reduction mammoplasty, and mastopexy. In some cases, prophylactic mastectomies to the opposite breast was performed on patients with unilateral breast cancer, with simultaneous reconstruction.

Attention to methods employed and timing of those procedures will be presented. The influence of the type of reconstruction utilized after the mastectomy on what will be done to the opposite breast will also be examined.