[A choice of reconstructive plastic surgery with endoprosthesis of the breast after radical mastectomy]

The creation of silicone endoprosthesis led to new approaches in solving the problems of plastic replacement of the breast after radical mastectomy. Two variants of reconstructive plastic operations with endoprosthetics of the breast were employed: group one--the formation of the seat of the endoprosthesis using a transposed musculocutaneous flap from the latissimus dorsi muscle; group two--the formation of the seat of the endoprosthesis by stretching the skin with a specially designed stretcher-expander and subsequent implantation of the endoprosthesis. The first method is rather injurious, sometimes cannot be performed because of anatomical contraindications, and is fraught with the development of necroses in the transposed tissues. Among 34 patients operated on by the first method two had marginal necrosis of the skin above the endoprosthesis. No complications were recorded among the 46 patients who underwent operation by the second method. The condition of the endoprosthesis and the tissues surrounding it was appraised in the immediate and late periods by radiological and ultrasonic examination. The variants of endoprosthetics of the breast which we applied may be employed with competence in clinical practice, but a reconstructive-plastic operation with the use of a skin expander is preferable.