Mastectomy: Reconstructive Considerations and Strategies

Abstract

In the modern era of multidisciplinary breast cancer management, breast conserving surgery has been established as the standard of care for early-stage disease when feasible to achieve oncological adequate margins and maintain the breast aesthetic. Despite advances in oncoplastic techniques and the increasing use of neoadjuvant systemic therapies that may broaden the scope of breast conservation, mastectomy is still playing an important role in breast surgery. This role includes not only the management of breast cancer, but also risk-reduction in women with high-risk predisposition genes. Currently, indications for mastectomy include inability or contraindication for adjuvant breast radiotherapy, lesions with high anticipated resection ratio and inflammatory breast cancer.

Mastectomy involves the removal of the entirety of the breast glandular tissue. This can be performed as a “simple” procedure also excising most of the overlying skin or with varying extent of skin preservation. With the evolution of surgical techniques, skin and nipple-sparing mastectomy have gained popularity and are now considered standard of care when oncologically appropriate. This approach facilitates immediate breast reconstruction, as it allows utilization of the preserved skin envelope to maximum benefit. The aim of this chapter is to provide an overview of the surgical techniques employed to perform a mastectomy and the reconstructive options following this procedure.