Less scarring or more symmetry? Reconstruction following metachronous bilateral breast cancer

摘要

We are encountering an increasing number of immediate reconstruction patients who have undergone a previous non-skin-sparing mastectomy and delayed autologous reconstruction and are subsequently faced with a meta-chronous cancer of the remaining native breast. If the patient is to undergo a skin-sparing mastectomy and is satisfied with her previous reconstruction, is it aesthetically preferable to preserve the native skin envelope and decrease scar burden, or is it better to include more skin with the planned autologous tissue transfer thereby maintaining symmetry with the previous reconstruction? Although much has been written on immediate reconstruction of the contralateral breast in cases of synchronous bilateral breast cancer or premalignant breast disease, no literature exists to guide decision-making in these meta-chronous cases.1'2 As 1% of patients may develop a contra-lateral, sequential breast cancer, this question is likely to persist.