Immediate Breast Reconstruction in Pregnancy and Lactation

It is estimated that 3 % of all breast cancers may be diagnosed in pregnant women, and the incidence of breast cancer in pregnant women is expected to increase owing to the postponement of childbearing. Management of this condition is a challenge because, in contrast to other areas of breast oncology, there are no large randomized trials to guide surgical and clinical practice. Breast reconstruction can be performed following a specific model designed in our breast unit since 2008, where patients are divided into three distinct groups: (1) first trimester—immediate reconstruction in one-step surgery with breast implants and contralateral breast symmetrization by breast reduction or mastopexy, or in two-step surgery with temporary expanders; (2) second and third trimester—temporary expanders; and (3) lactation—temporary expanders, autologous flaps, or breast-conserving therapy. If lactation ceased at least 3 months earlier, it is possible to perform one-step surgery with a definitive implant and contralateral breast symmetrization. In this situation, a breast conservative surgery approach is possible too. With this reconstructive approach it is possible to minimize the effects of mastectomy in this group of patients. It is a transverse model, which considers all aspects: oncologic, obstetric and reconstructive.