Breast reconstruction following mastectomy for malignant disease: a surgical oncologist's point of view

The various factors that enter into the decision and recommendation for breast reconstruction after mastectomy must include the time and number of procedures which may be required and the probability of recurrent cancer, but most of all, the degree of enthusiasm of the woman herself for the procedure. Only a small percentage of women who initially express interest in reconstruction actually carry it through to completion, for many reasons. What may have been considered initially as a "must" may lose its attractiveness with the passage of time and the realization that mutilation need not be an absolute synonym for mastectomy. Since there is no perfect reconstruction yet available, there cannot be any arbitrary and dogmatic rules established to separate the "should's" from the "should not's". We must await more technical advances from innovative surgeons and biomedical scientists before that millennium arrives. Concurrently, we must endeavor to find techniques of earlier and earlier detection, in the ultimate hope that the diagnosis of breast cancer may be made at a time early enough in its natural history that mastectomy would no longer be required and cure would be guaranteed!