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Breast Reconstruction After Mastectomy: Now or Later?
Date:9/20/2010

high, but I don't think they have been quantified," he noted.

The results, Pommier said, have changed his thinking. He now suggests that having a biopsy of the sentinel lymph node (the first to receive drainage from a tumor) before deciding whether to have immediate reconstruction would be wise. "If the sentinel node is negative, there is a low probability they would get radiation," he explained.

This biopsy is typically done at the start of the mastectomy, he said. But it can be done as a 30-minute outpatient procedure before the mastectomy is scheduled and before the reconstruction decision is made. In determining who will need radiation after mastectomy, doctors consider biopsy results as well as other factors, such as tumor size.

In the second study, researchers from the University of California, San Francisco, found that chemotherapy, either before or after the mastectomy and immediate reconstruction, had no bearing on complications and the need for more procedures.

Overall, 31 percent of 163 patients studied (some of whom received chemo, and some who did not) had a complication that required a return trip to the operating room. But the rate didn't differ based on whether the woman received chemo before surgery, after, or not at all.

The two new studies are putting some numbers behind what doctors have observed in patients, said Dr. Joanne Mortimer, director of the women's cancer program at City of Hope Comprehensive Cancer Center in Duarte, Calif., who reviewed the findings.

"I think they actually put in writing what physicians have appreciated clinically," she said.

While immediate reconstruction can help a woman cope psychologically, Mortimer said, sometimes it is not best in the long run if a woman needs radiation.

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