[Immediate reconstruction after radical mastectomy for breast carcinoma with a Becker-type expander prosthesis]

In recent years, the breast has won importance from the female psychology point of view. After ablative surgery for cancer, the loss of the breast gives rise in the woman to a feeling of refusal of her new body shape. Reconstruction produces positive feelings in the patient. The best-used surgical technique for operable breast cancer is modified radical mastectomy. An immediate reconstruction of the missing breast is considered when the following conditions are fulfilled: desire for reconstruction, age of the patient, clinical and pathologic evaluation (tumor size-tumor grade-lymph-node status). After modified radical mastectomy with "en bloc" removal of axillary lymph nodes, an immediate reconstruction is performed by lining the surfaces with human fibrin glue (Tissucol) followed by the insertion of a prosthesis of appropriate size (Becker Expander Mammary Prosthesis-Type 1) in the subserratus-subpectoral position. Human fibrin lining reduces the incidence of capsular contracture and effusion production. A suction drain is placed in the axillary area and is removed after 5 days. The use of expanding-type prostheses means that the patient must return for further expanding. When the pathologic features are negative, the delayed nipple areola reconstruction is possible with the full-thickness skin grafts in the groin or in pre-existent appendectomy incision. By this procedure, adjuvant chemotherapy or radiation therapy can be performed if required. From 1987 to 1991 the procedure has been performed in 35 cases of mammary neoplasm (mean age 40 years) at INRCA Department of Surgery of Ancona). No evidence of adverse effect on the natural course of the breast disease for have been seen.(ABSTRACT TRUNCATED AT 250 WORDS)