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Plastisch-rekonstruktive Operationen bei Mammakarzinom

Reconstructive plastic surgery for breast cancer patients

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Zusammenfassung

Kleine Mammakarzinome können in 60–80% der Fälle Brust erhaltend operiert werden. Insbesondere bei über eine Quadrantektomie hinausgehenden Teilresektionen sind bei onkoplastischen Eingriffen zur Wiederherstellung einer adäquaten Brustform plastisch-rekonstruktive Verfahren erforderlich. Die Rekonstruktion der Brust nach Mastektomie ist Teil der Mammakarzinomtherapie. Mit ihr können der Heilungsprozess und das psychosoziale sowie psychosexuelle Wohlbefinden unterstützt werden. Daher sollte das Thema Brustrekonstruktion zum Zeitpunkt der primären Therapieplanung angesprochen und individuell erarbeitet werden. Festzulegen ist dabei, ob die Patientin grundsätzlich eine Brustrekonstruktion wünscht, welche Operationstechnik ihr individuell anzuraten ist und welcher Zeitpunkt hierfür als optimal angesehen wird. An Operationstechniken kommen Implantat-, Eigengeweberekonstruktion oder deren Kombination in Frage. Bei der Entscheidung für eine rein heterologe Rekonstruktion sollte die Notwendigkeit einer Postmastektomiebestrahlung ausgeschlossen sein, da die Kapselfibroserate nach Radiatio hoch ist und das ästhetische Ergebnis deutlich beeinträchtigt.

Abstract

Around 60–80% of patients with early breast cancer can be treated with breast-conserving therapy. For cases in which the resection volume extends beyond quadrantectomy, an adequate breast shape can be achieved only with oncoplastic reconstructive surgical techniques. Breast reconstruction after mastectomy plays a significant role in the therapeutic management of breast cancer. The reconstruction of a fairly natural breast can support the healing process, enhancing the patient’s psychosocial and psychosexual well-being. Therefore, the subject of breast reconstruction should be discussed individually with each patient at the time of primary therapy planning; the discussion should cover whether the patient wants breast reconstruction, which operative techniques are recommended, and what the optimal timing of the procedure would be. Heterologous and autologous reconstruction techniques are based on expander or implant surgery as well as on pedicled or free flaps or a combination of the two. If postmastectomy radiation is necessary, implant reconstruction is not the first choice because of the high rates of capsular contracture and, thus, impaired aesthetic results.

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  1. Frauenklinik, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    C. Nestle-Krämling & W. Janni

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  1. C. Nestle-Krämling
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  2. W. Janni
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Correspondence to C. Nestle-Krämling.

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Nestle-Krämling, C., Janni, W. Plastisch-rekonstruktive Operationen bei Mammakarzinom. Onkologe 14, 1281–1292 (2008). https://doi.org/10.1007/s00761-008-1518-7

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  • DOI: https://doi.org/10.1007/s00761-008-1518-7

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