Breast Cancer Reconstruction
Description
Absence of the left breast with well-healed transverse mastectomy scar
Mastectomy skin flaps are tethered to anterior chest wall without evidence of radiation-associated skin changes.
The right breast has grade I ptosis, good skin tone, and elasticity.
There are no striae, discharge, or dimpling.
There is a roughly 2-cm well-healed transverse chest wall scar just superior to the right breast, consistent with previous port placement for chemotherapy.
Work-up
History
Type, size, and staging of tumor (tumor, node, metastasis [TNM] classification helpful).
Oncologic surgical technique (e.g., modified radical mastectomy, lumpectomy)
If already treated, length of time in remission and any evidence of recurrence.
History of chemotherapy/radiation therapy, plans for any further treatment.
Current breast size, desired breast size.
Family history of breast cancer, including BRCA testing (if performed).
Date and results of most recent mammogram.
History of smoking/tobacco use.
Patient′s reconstructive desires and expectations.
Physical examination
Body mass index (BMI): Weight (kg)/[height (m)]2
BMI > 35: Patient is poor candidate for free TRAM (transverse rectus abdominis myocutaneous) reconstruction.
Mastectomy site deformity: Quality and quantity of skin, presence of radiation changes, location of scar(s).
Unaffected breast: Size, shape, projection, skin quality, degree of ptosis, presence of masses and lymphadenopathy.
Overall body habitus and donor site availability.
Abdominal wall and back scars.
Pertinent imaging or diagnostic studies
Mammogram (especially if operating on unaffected breast).
Consultations
General surgery/surgical oncology.
Medical oncology.
Radiation oncology (if needed).
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