DÄ internationalArchive10/2015Different Procedures Should Be on Offer
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Mastectomy undoubtedly constitutes a substantial obstacle to satisfaction and quality of life. The authors showed clearly that patients were explicitly more satisfied with their outcome after breast conserving treatment than patients who had had mastectomies. This is not surprising as the discrepancy in the aesthetic result is obviously high. Of greater interest, however, would have been a comparison between patients after breast conserving therapy and patients after mastectomy with subsequent breast reconstruction. The authors did not comment in the present article whether breast reconstruction had any effect on patients’ satisfaction.

According to the current S3 guideline, every patient who had to undergo a mastectomy should be informed about and offered a choice of different procedures for reconstruction of the breast. Implant based reconstruction as well as breast reconstruction using the patient’s own tissue (flap reconstruction) are possible in certified breast centers using interdisciplinary approaches, owing to the increasing standardization of surgical techniques with high success rates. Breast reconstruction is therefore an elementary component of modern breast cancer therapy, and the impressive positive effect on the quality of life in affected women has been confirmed several times (13).

In our view, the statement that “breast-conserving surgery should be preferred whenever it can be medically justified” needs to be further qualified. Although breast-conserving treatment should be the aspired objective, mastectomy with subsequent breast reconstruction can yield aesthetically more pleasing results in the individual case scenario. Competent interdisciplinary advice and careful planning of therapy and surgery are the crucial prerequisites of an optimal oncological and aesthetic outcome.

DOI: 10.3238/arztebl.2015.0175b

Dr. med. Jochen-Frederick Hernekamp

PD. Dr. med. Thomas Kremer

Prof. Dr. med. Ulrich Kneser

Klinik für Hand-, Plastische- und rekonstruktive Chirurgie,
Schwerbrandverletztenzentrum

BG Unfallklinik Ludwigshafen

jfhernekamp@bgu-ludwigshafen.de

Prof. Dr. med. Jörg Heil

Universitätsfrauenklinik Heidelberg

Prof. Dr. med. Christof Sohn

Universitätsfrauenklinik Heidelberg

Conflict of interest statement

The authors declare that no conflict of interest exists.

1.
Guyomard V, Leinster S, Wilkinson M: Systematic review of studies of patients` satisfaction with breast reconstruction after mastectomy. Breast 2007; 16: 547–67. CrossRef MEDLINE
2.
Ng SK, Hare RM, Kuang RJ, et al.: Breast reconstruction post mastectomy: patient satisfaction and decision making. Ann Plast Surg 2014: Epub ahead of print. CrossRef
3.
Liu C, Zhuang Y, Momeni A, et al.: Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument Breast-Q. Breast Cancer Res Treat 2014; 146: 117–26. CrossRef MEDLINE
4.
Feiten S, Dünnebacke J, Heymanns J, et al.: Breast cancer morbidity— questionnaire survey of patients on the long term effects of disease and adjuvant therapy. Dtsch Arztebl Int 2014; 111: 537–44. VOLLTEXT
1.Guyomard V, Leinster S, Wilkinson M: Systematic review of studies of patients` satisfaction with breast reconstruction after mastectomy. Breast 2007; 16: 547–67. CrossRef MEDLINE
2.Ng SK, Hare RM, Kuang RJ, et al.: Breast reconstruction post mastectomy: patient satisfaction and decision making. Ann Plast Surg 2014: Epub ahead of print. CrossRef
3.Liu C, Zhuang Y, Momeni A, et al.: Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument Breast-Q. Breast Cancer Res Treat 2014; 146: 117–26. CrossRef MEDLINE
4.Feiten S, Dünnebacke J, Heymanns J, et al.: Breast cancer morbidity— questionnaire survey of patients on the long term effects of disease and adjuvant therapy. Dtsch Arztebl Int 2014; 111: 537–44. VOLLTEXT

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