الفهرس 
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Abstract
Breast reconstruction is an option for patients following a unilateral or bilateral mastectomy, or after breast conservation therapy that has had a less than ideal cosmetic result. Breast reconstruction provides psychological, social, emotional, and functional improvements, including improved psychological health, self-esteem, sexuality, and body image. Patients who choose breast reconstruction are presented with complex decisions, including the type and timing of reconstruction.
As the incidence of breast cancer continues to rise among women of all ages, the need for early detection becomes more pressing. A key to reducing the mortality from this disease is educating women that cure without permanent breast loss is possible if their cancer is diagnosed early. Mammography and breast examination are the main of breast cancer screening and early detection.
The mastectomy technique has changed dramatically in the past 50 years from the Halsted radical mastectomy, which sacrificed skin and muscle of the chest wall as well as the axillary anatomy. Today we know that the skin envelope of the breast can safely be preserved in the absence of direct tumor invasion. The breast tissue, the nipple areola complex, and the biopsy scar are included in the resected mastectomy specimen. In many cases, this can be achieved by performing the mastectomy through an obliquely oriented elliptical incision that encompasses the nipple areola complex and the adjacent biopsy scar. If the diagnosis of cancer has been made by fine-needle aspiration or needle-core biopsy, the mastectomy can be accomplished through a periareolar incision in many patients.
Breast reconstruction can be performed immediatly after mastectomy or can be delayed several months. The optimal time for reconstruction depends on the stage of breast cancer, the need for adjuvant therapy and the method of reconstruction.
There are three major classes of post mastectomy reconstruction: implant based reconstruction and autologous tissue based reconstruction or combination of both. Key to achieving the optimal aesthetic outcome is patient procedure selection. There are number of factors that can affect this decision. These include location of cancer and extent of resection, medical and surgical risk factors of the patient, need for adjuvant radiotherapy, availability of local and distant donor tissue, desired size and shape of the reconstructed breast, and most importantly patient preference. Individualized selection of a reconstructive technique for each patient is a predominant factor in achieving successful reconstruction.
Recent advancement in autologous breast reconstruction is the microsurgical free flap technique in which only skin and fat are harvested to recreate a natural-looking breast without disrupting the underlying muscle. Studies have shown that microsurgical breast reconstructions offer a more natural and durable reconstruction and minimize morbidity.
Types of free flaps commonly used in breast reconstruction:
1. Free TRAM frap
2. Deep Inferior Epigastric Artery Perforator (DIEP) flap.
3. Gluteal Artery Perforator (GAP) flap.
Superior Gluteal Artery Perforator (SGAP) flap.
Inferior Gluteal Artery Perforator (IGAP) flap.
DIEP flap reconstruction is a variation of the free TRAM flap reconstruction in which the same paddle of lower abdominal skin and fat is transferred for breast reconstruction with preservation of rectus abdominis muscle and fascia.
The DIEP flap combines all the advantages of the TRAM flap without most of its disadvantages. It provides generous amounts of well perfused soft tissue and its complication rate is similar to other free tissue transfers. The first and foremost advantage of the DIEP over the TRAM is its markedly decreased donor site morbidity. Furthermore, Postoperative pain is minimal, hospitalization time is reduced and patients can return more quickly to work and physical activities.
For patients who have insufficient tissue on the abdomen or have had previous abdominal surgery that compromises perfusion to the abdominal tissue, other options are available. The gluteal tissue can be used, based on its superior or inferior blood supply, known as the SGAP flap or the IGAP flap; these flaps allow the reliable transfer of skin and soft tissue from the Gluteal region without associated donor site morbidity.