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Many options exist for postmastectomy and postlumpectomy breast reconstruction.
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Surgeons must present all options to safely offer reconstruction, based on patient preferences and adjuvant treatment effects.
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Postmastectomy reconstruction outcomes have been enhanced, in terms of aesthetics and outcomes, by nipple-sparing mastectomy, autologous fat grafting, acellular dermal matrices, and prepectoral breast reconstruction.
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Reconstructive outcomes are heavily influenced by postmastectomy radiation
Breast Reconstruction
Section snippets
Key points
Postmastectomy breast reconstruction
After mastectomy, implant-based breast reconstruction is the most commonly performed option. Either through the traditional 2-stage approach with tissue expansion, or through the single-stage (direct to implant) approach, these options produce highly aesthetic breasts in a multitude of sizes (Fig. 1).6, 7
The immediate placement of a tissue expander or permanent implant at the time of mastectomy is preferable, owing to the ability to use the shape of the breast skin envelope and achieve an
Nipple-sparing mastectomy
In recent years, the frequency of nipple-sparing mastectomy being offered has increased significantly, owing to expanding indications and inclusion criteria.9 Equivalent locoregional recurrence rates to skin sparing mastectomy, in patients with stages 1 through 3 tumors, and no preoperative nipple skin involvement, has resulted in many more patients being offered this option. This factor has enhanced the appearance of breast reconstructive outcomes, because retention of the native nipple/areola
Postmastectomy radiation
Breast reconstruction in the setting of postmastectomy radiation therapy (PMRT) represents a particular challenge, owing to higher reported rates of incisional dehiscence, infection, and capsular contracture. Reported rates of overall complications in this setting range from 15% to 40%. This challenge occurs frequently with rates of PMRT in some centers reported at rates of 30% to 40%.14
When planning prosthetic reconstruction with PMRT, the surgeon must first decide whether radiation will be
Prepectoral breast reconstruction
Traditionally, prosthetic breast reconstruction after mastectomy has involved placing a tissue expander or permanent implant not only under the preserved breast skin, but also underneath the pectoralis major muscle. This was also assisted in coverage by incorporating the serrauts anterior muscle or fascia, or more recently, ADM for additional coverage.28 The purpose of such submuscular placement of prosthetic devices is the belief that this results in lower rates of capsular contracture,
Autologous fat grafting
Of all advances in breast reconstruction in the last 10 years, perhaps that with the greatest impact has been the advent of autologous fat grafting. With this technique, autologous fat can be harvested from a patient’s body using liposuction techniques. The fat is then washed, to remove blood and oil, and immediately reinjected into the breast for volume restoration, soft tissue augmentation, and masking of contour deformities.
In the setting of prosthetic breast reconstruction, this technique
Oncoplastic (postlumpectomy) breast reconstruction
Although postmastectomy breast reconstruction remains the most commonly performed oncologic reconstruction technique, the rise of oncoplastic breast reconstruction, performed alongside partial mastectomy (breast conservation) procedures, has been rapid. This finding is due to the potential severity of postlumpectomy breast defects, and the desire to avoid them. As such, 2 oncoplastic techniques are now commonly employed used the time of partial mastectomy: local tissue rearrangement and
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Cited by (25)
Is there an ideal timing for autologous fat grafting in implant-based breast reconstruction? Commentary on a systematic review and meta-analysis
2024, Journal of Plastic, Reconstructive and Aesthetic SurgeryPrepectoral Direct-To-Implant One-Stage Reconstruction With ADMs: Safety and Outcome in “Thin Patients”
2023, Clinical Breast CancerBreast reconstruction with silicone prosthesis and acellular dermal matrix of porcine origin: Retrospective study of 84 cases
2022, Annales de Chirurgie Plastique EsthetiqueCitation Excerpt :An increasing number of patients present sequelae, particularly aesthetic ones, following oncological treatment (medical and surgical treatments). The demand for breast reconstruction (BR) is growing leading to the development of numerous techniques which can be adapted to each woman [2]. There are techniques for reconstruction by free flap or not, giving excellent aesthetic results but are complex and not always accepted by patients.
Protective lipofilling in patients with irradiated implants: Preliminary analysis of immediate complications
2022, Revista Medica Clinica Las Condes
Disclosure Statement: Dr H. Sbitany is a consultant for Allergan, Inc. He received no compensation or support for this article.