Changing trends in postmastectomy breast reconstruction: a 13-year experience

Over the past two decades, significant advances have been made in the treatment of breast cancer and reconstruction following mastectomy. This analysis represents a 13-year review (1979-1991) of 455 postmastectomy reconstructions involving 381 patients (age range 25 to 76 years, mean 51 years). Follow-up was 6 months to 13 years (mean 5 years). Timing of the reconstruction, reconstructive techniques used, incidence of complications, and final results were determined. Reconstructions were divided into three chronologic study groups: group I, 1979-1983; group II, 1984-1987; and group III, 1988-1991. A significant increase in the use of autogenous reconstruction was identified: 13 percent in group I to 37 percent in group III (p < 0.0002). Complication rates were not significantly different among the three groups (p > 0.02). Significant decreases in the use of implants alone and the latissimus dorsi flap with implant were identified, while tissue expansion and TRAM flap use increased significantly (p < 0.002). Also, a significant increase in immediate reconstruction from 6 percent in group I to 28 percent in group III occurred (p < 0.0002). There was no significant difference in complication rates between immediate and delayed reconstruction in any study group. Operative time averaged 2 hours less for nonautogenous techniques; however, autogenous reconstruction required significantly fewer operative revisions. The identified trends toward immediate reconstruction and use of autogenous tissue have been accomplished without an increase in complications. Despite a decrease in overall implant use, the textured silicone saline-filled expander/implant remains the most frequently used device for breast reconstruction, providing a safe and predictable method to accomplish both immediate and delayed postmastectomy reconstruction.