الفهرس 
Introduction
Delayed Versus Immediate Breast Reconstruction (IBROnly 14 pages are availabe for public view
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Abstract
The incidence of local recurrence following mastectomy and immediate reconstruction of all types ranged from 0 to 11 % in earlier studies. Later on this rate has changed dramatically to 2.7% for local recurrence and 4.8% for locoregional recurrence in many studies. Recently, many studies concluded that, despite the different inclusion criteria (stage, type of mastectomy, adjuvant treatment, or immediate reconstruction technique), post-mastectomy immediate reconstruction has overall recurrence and survival rates comparable to those expected in women with the same characteristics who have not undergone reconstruction. But there is now clear evidence that neither implant-based nor autogenous tissue–based reconstruction has any effect on the incidence or detection of cancer recurrence. Multiple studies reported that all local recurrences following reconstruction were detected on follow-up clinical examination, and that no delay in diagnosis was due to the reconstructed breast. Current data indicate that reconstruction is safe and does not delay adjuvant therapy; chemotherapy or radiotherapy, or the detection of cancer recurrence. In addition, although the most frequent site of recurrent breast cancer is in the remaining chest wall skin, immediate reconstruction has not been shown to increase the rate of local recurrence in the long term. There are still many areas to improve in the quality of care given for breast cancer patients. Appropriate interventions should be implemented before and after the surgical procedure takes place. Conducting a randomized study that includes all treatment modalities is impossible nowadays, mainly because of ethical considerations. In the past, studies were carried out when patients were not aware of the equivalency of survival between mastectomy and breast-conserving surgery. Considering this, our efforts should be focused on the QOL of patients and on a proper psychological evaluation before and psychological support after the crisis. Behavioral techniques can be used to control the side effects of chemotherapy, like pain, nausea, and vomiting. Sexual adjustment could be addressed by an expert, along with complementary therapies, like massage or open discussions about the impact on sexuality. It is in the hands of medical caregivers to look beyond the “cold” surgical treatment of breast cancer and implement a more holistic approach to patient care. Moreover, appropriate patient-reported questionnaires must be developed, specifically addressing cosmetic and reconstructive breast surgery. Only then new studies will obtain a meaningful basis on which surgical results can be compared.