Clinic for Plastic Surgery, Medical University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck Tel.: 0049 451/500-2060, Fax: 0049 451/500-2190
email: mariannschrader@medinf.mu-luebeck.de

Dear chair,

Slide 1: It is an honor for me and the German association of women doctors to participate in this Silver Jubilee Congress and to be able to give this lecture.

In Germany, every year about 46,000 women are diagnosed with breast cancer. That means that each 9th to 10th woman is affected. More than 17,000 of these women are less than 60 years old at initial diagnosis. About 16,000 women die each year due to the disease. Therefore, breast cancer is the number one cause of death related malignancies.

In 1998, 34% of patients were not able to receive breast preserving therapy at our interdisciplinary mamma center. The type and extend of breast cancer made this approach impossible. Therefore, all possibilities for a postoperative breast reconstruction were already discussed preoperatively. This way the fear of a persistent disfigurement can be diminished, as we know.

We prefer an early secondary breast reconstruction in our hospital. This treatment depends upon

Slide 2: Left: Definitive histopathological diagnosis

- Finalized adjuvant chemotherapy

- No radiation

Our principles: The concept of treatment is a reestablishment of body shape with correction of scars and lost anatomic tissue by transplantation of tissue as similar to the originally removed as possible. Following this concept, an appropriate, save and risk-reduced treatment approach is worked up with each patient. We prefer the myocutaneous

Latissimus dorsi muscle flap to minimize the risk of weakening of the abdominal wall and the development of hernias.

Slide 3: Left: This 43year old patient asked for our help, because a painful scar impaired her ability of raising the left arm. At the same time the unilateral macro-mastia lead to mechanical problems of her spine. A breast cancer therapy without postoperative radiation had taken place 8 years ago. During the explanatory discussion the individual therapy in the picture to the right shown was elaborated.

Slide 3: Right: Replacement of missing skin and subcutis with flapping / thoraco-epigastric flap. Stretching of obtained tissue with tissue expander. Reduction of the right large breast with mammillary reconstruction left using parts of the right areola.

Left: Result of the first step of reconstruction with flapping to correct scars.

Slide 4: Right final result 9 years later. The entire right gland was removed while reducing and remodeling the breast. Histopathology showed no evidence of tumor.

Slide 5: Left: In this 49 year old patient a modified radical mastectomy was performed 1 year ago.

Right a derm expander was implanted from the submammary fold and filled to the desired size to produce a large fibrous tissue capsule for the implant.

Slide 6: The final symmetry was achieved by a totally new formation of the left breast. On the right the result 1 ½ years later.

Slide 7: This 45year old patient who presented with tight skin covering her thorax received a Latissimus dorsi flap for reconstruction.

On the right: After reconstruction of the right breast. Alignment with reduction plastic on the left modified by the technique of Lejour.

Slide 8: Result after 1 ¾ years.

On the right the hardly noticeable scar on the back after removal of the flap tissue.

Slide 9: Finally the pictures of a 52year old female who underwent mastectomy. At axillary dissection two lymph nodes were found positive for malignancy and consequentially she was treated with chemo-therapy. She did not receive radiation therapy.

The left picture captures the first step of reconstruction with myocutaneous Latissimus dorsi flap on the right breast.

The left breast with marking lines for reduction mammaplasty using the technique that was modified after Lejour Lasuss. The right picture shows the resulting scar after vertical excision of the flap.

Slide 10: On the left the final body shape achieved after 3 operative steps.

The right picture shows a small watercolor painting done by the patient after reconstruction of her lost breast. In my view it demonstrates best how much joy of life this patient gained back.

The reconstruction of a breast is nowadays a standard procedure in the therapy concept of breast cancer. The subjective judgement of the life threatening organ loss leads to the fact that some patients may become latently suicidal. The earliest possible information about the possibility of breast reconstruction has proven very psychologically helpful. Therefore, breast reconstruction cannot be regarded as a surgical technique only, but an effective tool for psychotherapy.

Biography

Prof. Dr. Marianne Schrader works as a plastic surgeon in the Medical University of Lübeck, a town near the southwest coastal area of the Baltic Sea. She is a member of the German Medical Women Association and belongs to MWIA Central Europe.

Her scientific and clinical topics:

• Breast diseases
• Hand malformations
• Dupuytren’s diseases