Which of the following statements are true about reconstruction of the breast following mastectomy?

A. A permanent prosthesis or tissue expander may be inserted at the time of the ablative surgery.

B. If the patient requires adjuvant chemotherapy or radiation therapy, reconstruction of the breast is delayed until completion of the treatment.

C. Extensive postmastectomy defects require the use of a flap.

DISCUSSION: Reconstruction can be initiated at the time of the ablative surgery, using a 6-cm. slightly curved incision at the level of the sixth rib through the serratus muscle. A pocket is created beneath the serratus and pectoralis major muscles, extending medially to the perforating internal mammary vessels and inferiorly beneath the fascial insertion of the rectus abdominis muscle. A tissue expander prosthesis is inserted into the pocket. If the patient requires adjuvant chemotherapy or radiation therapy, reconstruction of the breast is delayed until treatment is completed and an adequate recovery period has passed. If the quantity or quality of the chest skin or the pectoralis major muscle is insufficient, tissue must be brought in from adjacent areas. A latissimus dorsi musculocutaneous flap may be transferred on its blood supply via the thoracodorsal artery and vein. Extensive postmastectomy defects necessitate the use of the larger rectus abdominis musculocutaneous flap, which is based on the superior epigastric vessels. A “free” microvascular rectus abdominis or other myocutaneous flaps may be used. The thoracodorsal or anterior serratus vessels can usually be anastomosed to the inferior epigastric vessels of the rectus abdominis flap.