Breast reconstruction after mastectomy: interface between oncologic and reconstructive surgery

Abstract

Background: Breast reconstruction after mastectomy: interface between oncologic and reconstructive surgery addresses breast defects following oncologically indicated mastectomy, a clinical problem that often requires coordinated action by general and reconstructive surgeons. Procedure choice is influenced by the extent of the defect and by associated systemic and local risk factors. Objective: To critically discuss patient selection, reconstructive options, complications and the strength of the available evidence. Methods: This descriptive narrative review, rather than a systematic review or meta-analysis, was based on a directed reading of clinical guidelines, consensus statements and published reviews retrieved from institutional and bibliographic resources. No individual patient data were collected and no original numerical treatment effects were calculated. Results and discussion: The main decision pathway involves shared selection of immediate or delayed, implant-based or autologous reconstruction. Important adverse outcomes include ischemia of mastectomy skin, infection, radiation-related complications and donor-site morbidity. Selection requires evaluation of the patient, the anatomy of the defect, vascular supply, infection status, nutritional risk and the resources of the treatment center. The timing of the operation should reflect physiological stability, wound-bed conditions and the need to control any ongoing disease process. The reviewed evidence combines guidelines, observational studies and systematic reviews; results from different populations cannot automatically be extrapolated to an individual patient. Conclusion: Safe reconstructive planning should balance technical feasibility, functional restoration, donor-site harm and longitudinal follow-up. The best approach is context-dependent and should be decided with a multidisciplinary team.