Chapter 1 resection by the oncological surgeon and, subsequently, a good distribution of breast tissue with a relocation of the nipple through the many breast reduction possibilities available to the plastic surgeon. This is ideal in patients with larger and/or ptotic breasts, where simultaneous correction with a smaller and non‐ptotic breast is viewed as a positive outcome. As opposed to breast reshaping, the volume‐replacing breast‐ conserving surgery uses regional flaps to fill the defect in the breast. This is ideal when a patient has non‐ptotic breasts and when the patient does not want volume reduction.15 However, there are absolute and relative contraindications for breast‐conserving therapy, such as local recurrence, prior radiation therapy, pregnancy, multi‐ centric/multifocal tumors, inability to obtain tumor‐free resection margins after lumpectomy, T4 tumors, inability to tolerate radiation therapy, and a large tumor‐to‐ breast size ratio. These patients are usually treated with mastectomy. Other reasons for mastectomy in breast cancer patients include contralateral prophylactic mastectomy in patients with a high lifetime risk for developing contralateral breast cancer (BRCA positive, strong family history, or young patients). Genetic predisposed individuals (BRCA1 and BRCA2) may also opt for prophylactic bilateral mastectomy and reconstruction. Some patients are also good candidates for breast‐conserving therapy but prefer to choose ablative surgery with or without reconstruction. The modern treatment of breast cancer involves many disciplines and does not only include ablative surgery, radiation, and systemic therapy but also offers reconstructive procedures to achieve a pleasing aesthetic outcome for the patients. Current options for breast reconstruction after mastectomy Possibilities for a breast reconstruction have improved in the last decades because of development in surgical and prosthetic techniques.18 As a result, the number of women choosing breast reconstruction has increased not only because of the expanded options but also because surgical outcomes have improved. Reconstructive surgeons can safely and effectively perform breast reconstruction using either autologous tissue or implantable devices. Innovations in autologous breast reconstruction as well as in implants have provided women with safer and more effective options when considering reconstruction after mastectomy. In addition, breast reconstruction can be performed safely because such procedures are not associated with an increased or delayed diagnosis of local recurrence.5,19 Breast reconstruction supports the recovery of patients to a great extent because it reduces the psychological, social, and sexual morbidity associated with loss of a breast. Patients who have undergone a breast reconstruction are generally satisfied with the result and have more self‐confidence, especially on a psychosocial level.20 Body image and sexual relationship are improved after reconstruction.21 Breast reconstruction can be done in a primary or direct setting or in a secondary or delayed setting. Factors that play a role in the decision making as to whether to perform a primary or a secondary reconstruction are the tumor stage 12
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