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Invited Critique
December 1, 2005

Reconstructive Breast Implantation After Mastectomy for Breast Cancer—Invited Critique

Arch Surg. 2005;140(12):1160-1161. doi:10.1001/archsurg.140.12.1160

Studies from the United States demonstrate that postmastectomy immediate and early reconstruction is underutilized, with overall reconstruction rates of approximately 15% of mastectomies, with a significant regional variation. This represents a 147% increase from 1992, which is partly attributable to the Women’s Health and Cancer Rights Act of 1998 that mandates insurance coverage for reconstruction.1 The Canadian experience, representing a disparate health care outlook and financing model, yields comparably low reconstruction rates of approximately 8%.2,3 In many patients, autologous tissue such as TRAM [transverse rectus abdominis myocutaneous], free TRAM, or DIEP [muscle sparing, using the superficial epigastric artery or the inferior epigastric artery] flaps may afford superior results in the long term.4 However, based on patient preference or unsuitability for autologous tissue reconstruction, about 24% of these patients undergo implant-based reconstruction with saline, silicone, or dual-chambered implants. Countless studies demonstrate excellent outcomes in terms of patient satisfaction, self-image improvement, and overall safety using breast implantation in this patient subpopulation. Sound methods, such as the Medical Outcomes Study 36-Item Short-Form Health Survey, have been used to establish these international practice norms.