Table 1. Key points.
| Incidence of breast cancer 1 in 8 in Australia |
| Only 33% choose to have reconstruction despite an 82% psychosocial improvement |
| Implant use has increased by 11% per year from 1998-2008 and now exceeds autologous reconstruction |
| Indication and patient selection |
| Most patients are candidates for prosthetic reconstruction |
| Consider clinicopathological features when making decision |
| Patients with small, minimally ptotic breasts are suitable for immediate reconstruction |
| Patients with large, ptotic breasts or who need radiotherapy are better suited to delayed reconstruction |
| Breast reconstruction in the elderly |
| Older patients tolerate reconstruction well and can have fewer complications |
| Risks and complications |
| Common complications-capsular contracture, hematoma and infection |
| Risks for complications-smoking, obesity, large breast volume, diabetes, higher grade tumors |
| Multifactorial-bacterial colonization, type/texture/placement of implant and radiotherapy |
| Incidence of significant capsular contracture up to 209% |
| Types of prostheses |
| Silicone vs. saline |
| Higher capsular contracture rate in silicone |
| Higher satisfaction and quality of life scores for silicone |
| Silicone not associated with cancer, immunological or systemic disease |
| Round vs. anatomic |
| No significant difference |
| Anatomic implants may feel firmer and have less rippling |
| Textured vs. smooth |
| Textured have lower risk of capsular contracture |
| Smooth more likely to be displaced and cause more pain on expansion |
| Integrated vs. distant port |
| No significant difference |
| Timing of reconstruction |
| Immediate |
| Best aesthetic outcomes if no radiotherapy needed |
| Higher rate of complications, capsular contracture, implant failure and revision surgery |
| Delayed-immediate |
| Achieve similar aesthetic results to immediate reconstruction |
| Preserves the breast skin if radiotherapy required |
| Delayed |
| Fewer complications than immediate reconstruction |
| Better aesthetic results if radiotherapy required compared to immediate reconstruction |
| “Delayed-delayed”-for locally advanced breast cancer patients requiring neoadjuvant chemotherapy. Improves aesthetics and reduces psychological disadvantages associated with DBR |
| Radiotherapy |
| Increases risk of capsular contracture-occurs in 68% of irradiated breasts |
| Higher risk of complications and reconstruction failure |
| More likely to need revision surgery |
| Lower patient satisfaction with outcome |
| Outcomes |
| High satisfaction rates with prosthetic reconstruction |
| Cosmesis better accepted if patient better informed |
| Better aesthetic outcomes associated with having bilateral reconstruction and not having radiotherapy |
| Patients receive best treatment in hospitals with multidisciplinary breast team |
DBR, delayed breast reconstruction.