Breast Reconstruction after Breast-Cancer Surgery

Abstract

Cordeiro (Oct. 9 issue)¹ describes a patient who may undergo postoperative radiation therapy after mastectomy. He states that the best therapeutic option would be prosthesis-based breast reconstruction. Because of the patient's limited abdominal tissue, the possible use of the superior gluteal artery perforator (SGAP) flap is mentioned but rejected in favor of an expander–implant approach. However, this operative approach is at odds with the results of several studies confirming the significantly increased risk of capsular contracture and other secondary complications in patients who received radiation as compared with patients with implants who did not receive radiation^2,3 and as compared with patients undergoing autogenous breast reconstruction who received radiation.⁴ Hence, we would strongly recommend autogenous-tissue transfer in this patient, so as to avoid the radiotherapy-related risk of formation of a capsular contracture. Free microvascular transplantation of the SGAP flap would provide an excellent long-lasting cosmetic result in this patient. This procedure may be performed with insufficient abdominal tissue, as in the patient described by Cordeiro, or even after previous transfer of a deep inferior epigastric perforator flap for autogenous reconstruction of the contralateral breast ( Figure 1 ).