Breast Cancer - Arab Medical Association Against Cancer

Surgery 138Contralateral breast managementThe actual tendency of breast cancer treatment is to be as large as possible but with preservation of thebody morphology. For this reason, a contralateral breast surgery is necessary to achieve symmetry. In ourexperience, 60% of the breast reconstruction cases required a contralateral correction; and in cases ofconservative treatment with mammopla association, the better results are achieved with application of thesame technique bilaterally.Furthermore, the contralateral intervention can be helpful to perform an opposite b screening with acomplete bimanual glandular exploration and multiple biopsies. A van incidence from 5% to 11% ofclinical and radiological occult tumors was shown.Areola and nipple reconstructionThis is the final touch after a breast reconstruction. Normally it is recommended to postpone the secondstage intervention to avoid a malpositioning of the nipple and areola complex. Tattooing is the mostsimple technique to areola reconstruction. For the nipple reconstruction, a tattooed skin flap or a partialcontralateral nipple graft can be used (photo 13).Particular indications of large excisions on the thoracic wall can be used for palliative or cleanlinesspurposes (local recurrence treatment or radionecrotic sequellae). The solutions to cover this area must bediscussed case by case and some techniques are most useful: skin grafts, local skin flaps, myocutaneousflaps or omentum flap. The last one is specially used when the internal mammary vessels have beeninvolved in the thoracic ulceration or when pedicled TRAM flap is no more available.ConclusionNowadays, the plastic surgery is a part of breast cancer treatment. It helps the women to preserve theirbody appearance, their well being and their quality of life. For this reason, a perfect interaction withgeneral surgeons, radiotherapist and chemotherapist allows the better treatment association for each casetaking into account the disease phase and patient's wishes.Table 16.1. Different Types of Definitive ProsthesisFilled Material Shell Shape CommentsGel Smooth TexturedPolyurethane cover Round Round or AnatomicalRound Recommended change every 10 yearsCapsular contracture rates probably lowerthan smooth prosthesis.Good results with anatomical shape.Recommended change every 10 years.Prosthesis with the smallest rates of capsularcontracture.Not recommended by the FDA.Saline Solution Smooth Textured RoundRound or Anatomical Risks of deflation.No changes recommended.Risks of deflation.No changes recommended.Double Lumen Smooth Round Risks of deflation.Recommended change every 10 years.Hydrogel Peanut oil or Not yet available for human implantation.Table 16.2. Different Types of Expanders