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Medicina
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Updates on Post-mastectomy Breast Reconstruction
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Updates on Post-mastectomy Breast Reconstruction

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (30 May 2024) | Viewed by 13554

Special Issue Editors

Dr. Glenda Giorgia Caputo

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Guest Editor
Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of Udine, University of Udine, Udine, Italy
Interests: breast surgery; microsurgery
Dr. Rossella Sgarzani

E-Mail Website
Guest Editor
Department of Experimental, Diagnostic and Specialty Medicine, Bologna University, 40126 Bologna, Italy
Interests: breast reconstruction; robotic surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Pier Camillo Parodi

E-Mail Website
Guest Editor
Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medicine (DMED), University of Udine, Udine, Italy
Interests: plastic surgery; reconstructive surgery; microsurgery; free flap; free tissue transfer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thanks to new technologies such as last-generation breast implants, biologic and synthetic matrices and even more conservative mastectomies, breast reconstruction is becoming increasingly challenging and tailored to the patient.

Of the different types of plastic surgery targeted to various parts of the body, reconstructive surgery of the breast is the one that covers the widest range of fields, including in fact autologous reconstruction with flaps (microsurgical or not), heterologous reconstruction with implants, hybrid reconstructions, lipograft and regenerative surgery. In such a various scenario, every surgeon has developed their personal approach to different techniques and refined their practice in a personalized manner. With this Special Issue, we wish to give a voice to surgeons who want to share their workhorse and their experiences with the latest advancements in post-mastectomy breast reconstruction.

Dr. Glenda Giorgia Caputo
Dr. Rossella Sgarzani
Prof. Dr. Pier Camillo Parodi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

 

Keywords

  • post-mastectomy breast reconstruction
  • DIEP flap
  • PAP flap
  • breast implants
  • ADMs
  • synthetic meshes
  • direct-to-implant, two-stages
  • flap monitoring
  • TMG-flap

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Published Papers (6 papers)

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Research

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12 pages, 1258 KiB  
Article
Breast Reconstruction in Patients with Prior Breast Augmentation: Searching for the Optimal Reconstructive Option
by Pasquale Tedeschi, Rossella Elia, Angela Gurrado, Eleonora Nacchiero, Alessia Angelelli, Mario Testini, Giuseppe Giudice and Michele Maruccia
Medicina 2024, 60(10), 1663; https://doi.org/10.3390/medicina60101663 - 10 Oct 2024
Viewed by 632
Abstract
Background and Objectives: Breast cancer in patients with prior breast augmentation poses unique challenges for detection, diagnosis, and management. Mastectomy rates are increasing, and patients with prior augmentation often have a lower body mass index, making autologous techniques unsuitable. This study aims [...] Read more.
Background and Objectives: Breast cancer in patients with prior breast augmentation poses unique challenges for detection, diagnosis, and management. Mastectomy rates are increasing, and patients with prior augmentation often have a lower body mass index, making autologous techniques unsuitable. This study aims to assess the best reconstructive option in patients with a history of subglandular or dual-plane breast augmentation. Materials and methods: A prospective analysis was conducted on patients who underwent breast reconstruction after mastectomy. Patients with subglandular or dual-plane breast augmentation were included. Patients were divided into submuscular breast reconstruction (Group 2) or prepectoral breast reconstruction (Group 1) groups. Demographic and surgical data were collected. Results: A total of 47 patients were included, with 23 in Group 1 and 24 in Group 2. Complications occurred in 11 patients (23.4%), with significant differences between groups. The most common complication was seroma formation. Implant loss occurred in 4.3% of cases in Group 1, while no implant loss was observed in Group 2. Patient-reported satisfaction scores were similar between groups at 12 months postoperatively. Conclusions: Subpectoral breast reconstruction with a tissue expander seems a safer and effective technique for patients with prior breast augmentation. It resulted in fewer complications. This approach should be considered as an option for breast reconstruction after mastectomy in this cohort of patients. Full article
(This article belongs to the Special Issue Updates on Post-mastectomy Breast Reconstruction)
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11 pages, 7180 KiB  
Article
Redefining the Axillary Aesthetic: Surgical Management of Axillary Tissue Hypertrophy
by Neil Tanna, Sarah Barnett, Christopher Aiello, Lucas M. Boehm and M. Bradley Calobrace
Medicina 2024, 60(1), 126; https://doi.org/10.3390/medicina60010126 - 10 Jan 2024
Viewed by 2714
Abstract
Background and Objectives: Axillary tissue hypertrophy consists of ectopic breast tissue and occurs in up to six percent of women. Women complain of pain, interference with activity, and dissatisfaction with appearance. While it is recommended that accessory breast tissue be removed via surgical [...] Read more.
Background and Objectives: Axillary tissue hypertrophy consists of ectopic breast tissue and occurs in up to six percent of women. Women complain of pain, interference with activity, and dissatisfaction with appearance. While it is recommended that accessory breast tissue be removed via surgical excision, there is lack of consensus on the best technique for the surgical management of axillary tissue hypertrophy. In this study, the senior authors (BC and NT) review outcomes and complications as they pertain to the surgical treatment of axillary tissue hypertrophy and axillary contouring. Materials and Methods: A retrospective review of all patients (n = 35), from two separate institutions, who presented with axillary tissue hypertrophy between December 2019 and August 2021 was conducted. All patients underwent a technique that included direct crescentic dermato-lipectomy and glandular excision with axillary crease obliteration. Tissue was sent for histological analysis after removal. During a six-month follow-up period, all patient outcomes were recorded. Results: The authors treated 35 women with axillary tissue hypertrophy. All patients complained of aesthetic deformity with significant discomfort leading to the desire for surgery. Histologically, all specimens contained benign breast and adipose tissue. Hypertrophic scarring, seroma, and axillary cording were noted complications. Conclusions: Detailed is the surgical management and optimal technique that can be used to treat both adipose and fibroglandular axillary tissue hypertrophy while simultaneously providing a favorable axillary aesthetic. Full article
(This article belongs to the Special Issue Updates on Post-mastectomy Breast Reconstruction)
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11 pages, 1573 KiB  
Article
Optimizing Acellular Dermal Matrix Integration in Heterologous Breast Reconstructive Surgery: Surgical Tips and Post-Operative Management
by Glenda Caputo, Anna Scarabosio, Jacopo Di Filippo, Filippo Contessi Negrini, Roberta Albanese, Sebastiano Mura and Pier Camillo Parodi
Medicina 2023, 59(7), 1231; https://doi.org/10.3390/medicina59071231 - 30 Jun 2023
Cited by 4 | Viewed by 1749
Abstract
Background and Objective: Prepectoral implant placement in breast reconstruction is currently a must-have in the portfolios of breast surgeons. The introduction of new tools and conservative mastectomies is a game changer in this field. The prepectoral plane usually goes hand-in-hand with the [...] Read more.
Background and Objective: Prepectoral implant placement in breast reconstruction is currently a must-have in the portfolios of breast surgeons. The introduction of new tools and conservative mastectomies is a game changer in this field. The prepectoral plane usually goes hand-in-hand with the ADM wrapping of the implant. It is a cell-free dermal matrix comprising a structurally integrated basement membrane complex and an extracellular matrix. The literature reports that ADMs may be useful, but proper patient selection, surgical placement, and post-operative management are essential to unlock the potential of this tool, as these factors contribute to the proper integration of the matrix with surrounding tissues. Materials and Methods: A total of 245 prepectoral breast reconstructions with prostheses or expanders and ADMs were performed in our institution between 2016 and 2022. A retrospective study was carried out to record patient characteristics, risk factors, surgical procedures, reconstructive processes, and complications. Based on our experience, we developed a meticulous reconstruction protocol in order to optimize surgical practice and lower complication rates. The DTI and two-stage reconstruction were compared. Results: Seroma formation was the most frequent early complication (less than 90 days after surgery) that we observed; however, the majority were drained in outpatient settings and healed rapidly. Secondary healing of wounds, which required a few more weeks of dressing, represented the second most frequent early complication (10.61%). Rippling was the most common late complication, particularly in DTI patients. After comparing the DTI and two-stage reconstruction, no statistically significant increase in complications was found. Conclusions: The weakness of prepectoral breast reconstruction is poor matrix integration, which leads to seroma and other complications. ADM acts like a graft; it requires firm and healthy tissues to set in. In order to do so, there are three key steps to follow: (1) adequate patient selection; (2) preservative and gentle handling of intra-operative technique; and (3) meticulous post-operative management. Full article
(This article belongs to the Special Issue Updates on Post-mastectomy Breast Reconstruction)
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Review

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13 pages, 925 KiB  
Review
BIA-ALCL and BIA-SCC: Updates on Clinical Features and Genetic Mutations for Latest Recommendations
by Gennaro D’Orsi, Martina Giacalone, Alessio Calicchia, Elettra Gagliano, Lisa Vannucchi, Gianluca Vanni, Oreste Claudio Buonomo, Valerio Cervelli and Benedetto Longo
Medicina 2024, 60(5), 793; https://doi.org/10.3390/medicina60050793 - 10 May 2024
Cited by 1 | Viewed by 3951
Abstract
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and Breast Implant-Associated Squamous Cell Carcinoma (BIA-SCC) are emerging neoplastic complications related to breast implants. While BIA-ALCL is often linked to macrotextured implants, current evidence does not suggest an implant-type association for BIA-SCC. Chronic inflammation and [...] Read more.
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and Breast Implant-Associated Squamous Cell Carcinoma (BIA-SCC) are emerging neoplastic complications related to breast implants. While BIA-ALCL is often linked to macrotextured implants, current evidence does not suggest an implant-type association for BIA-SCC. Chronic inflammation and genetics have been hypothesized as key pathogenetic players, although for both conditions, the exact mechanisms and specific risks related to breast implants are yet to be established. While the genetic alterations in BIA-SCC are still unknown, JAK-STAT pathway activation has been outlined as a dominant signature of BIA-ALCL. Recent genetic investigation has uncovered various molecular players, including MEK-ERK, PI3K/AKT, CDK4-6, and PDL1. The clinical presentation of BIA-ALCL and BIA-SCC overlaps, including most commonly late seroma and breast swelling, warranting ultrasound and cytological examinations, which are the first recommended steps as part of the diagnostic work-up. While the role of mammography is still limited, MRI and CT-PET are recommended according to the clinical presentation and for disease staging. To date, the mainstay of treatment for BIA-ALCL and BIA-SCC is implant removal with en-bloc capsulectomy. Chemotherapy and radiation therapy have also been used for advanced-stage BIA-ALCL and BIA-SCC. In-depth characterization of the tumor genetics is key for the development of novel therapeutic strategies, especially for advanced stage BIA-ALCL and BIA-SCC, which show a more aggressive course and poor prognosis. Full article
(This article belongs to the Special Issue Updates on Post-mastectomy Breast Reconstruction)
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13 pages, 300 KiB  
Review
Current Global Trends in Prepectoral Breast Reconstruction
by Saima Taj, Ravi Chandavarkar and Raghavan Vidya
Medicina 2024, 60(3), 431; https://doi.org/10.3390/medicina60030431 - 3 Mar 2024
Cited by 1 | Viewed by 2005
Abstract
Implant-based breast reconstruction (IBBR) is the most frequently performed procedure for breast reconstruction following mastectomy, which involves the surgical placement of breast implants. The approach to breast reconstruction can be divided into two main categories, namely prepectoral breast reconstruction (PPBR) and subpectoral breast [...] Read more.
Implant-based breast reconstruction (IBBR) is the most frequently performed procedure for breast reconstruction following mastectomy, which involves the surgical placement of breast implants. The approach to breast reconstruction can be divided into two main categories, namely prepectoral breast reconstruction (PPBR) and subpectoral breast reconstruction (SPBR), based on the implant plan and placement technique. In recent years, there has been a significant surge in the popularity of prepectoral implant-based breast reconstruction, where the implants are positioned above the chest muscle, as opposed to beneath it in the subpectoral approach. However, despite this growing preference, there is a lack of comprehensive data regarding the national trends in the utilization of this technique, thus necessitating further investigation. This narrative review aims to ascertain the current global patterns linked to prepectoral breast reconstruction and elucidate the considerations surrounding patient and implant selection, reconstructive techniques, the utilization of meshes in prepectoral reconstruction, the ensuing outcomes and complications, the ramifications of radiotherapy, and the potential advantages of integrating fat infiltration into the implementation of this technique in breast reconstruction with a focus on published papers in last five years. Conclusion: Prepectoral breast reconstruction has emerged as an appropriate surgical option for individuals seeking breast reconstruction. This development can be attributed to the recent progress made in implant technology, which has significantly enhanced the outcomes of this procedure. Additionally, advancements in mastectomy techniques, autologous fat grafting, and the use of acellular dermal matrices (ADMs) have also played a vital role in improving the aesthetic results of prepectoral breast reconstruction. As a result, the significance and effectiveness of this technique in the field of breast reconstruction have been firmly established, making it an essential component of the overall armamentarium available to plastic surgeons for breast reconstruction purposes. Full article
(This article belongs to the Special Issue Updates on Post-mastectomy Breast Reconstruction)

Other

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18 pages, 736 KiB  
Systematic Review
Post-Mastectomy Breast Reconstruction Disparities: A Systematic Review of Sociodemographic and Economic Barriers
by Kella L. Vangsness, Jonathan Juste, Andre-Philippe Sam, Naikhoba Munabi, Michael Chu, Mouchammed Agko, Jeff Chang and Antoine L. Carre
Medicina 2024, 60(7), 1169; https://doi.org/10.3390/medicina60071169 - 19 Jul 2024
Viewed by 1310
Abstract
Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but [...] Read more.
Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but there remain social, economic, and geographical barriers to receiving reconstruction. Threats to equitable healthcare for all breast cancer patients in America persist despite growing awareness and efforts to negate these disparities. While race/ethnicity has been correlated with differences in BR rates and outcomes, ongoing research outlines a multitude of issues underlying this variance. Understanding the current and continuous barriers will help to address and overcome gaps in access. Methods: A systematic review assessing three reference databases (PubMed, Web of Science, and Ovid Medline) was carried out in accordance with PRISMA 2020 guidelines. A keyword search was conducted on 3 February 2024, specifying results between 2004 and 2024. Studies were included based on content, peer-reviewed status, and publication type. Two independent reviewers screened results based on title/abstract appropriateness and relevance. Data were extracted, cached in an online reference collection, and input into a cloud-based database for analysis. Results: In total, 1756 references were populated from all databases (PubMed = 829, Ovid Medline = 594, and Web of Science = 333), and 461 duplicate records were removed, along with 1147 results deemed ineligible by study criteria. Then, 45 international or non-English results were excluded. The screening sample consisted of 103 publications. After screening, the systematic review produced 70 studies with satisfactory relevance to our study focus. Conclusions: Federal mandates have improved access to women undergoing postmastectomy BR, particularly for younger, White, privately insured, urban-located patients. Recently published studies had a stronger focus on disparities, particularly among races, and show continued disadvantages for minorities, lower-income, rural-community, and public insurance payers. The research remains limited beyond commonly reported metrics of disparity and lacks examination of additional contributing factors. Future investigations should elucidate the effect of these factors and propose measures to eliminate barriers to access to BR for all patients. Full article
(This article belongs to the Special Issue Updates on Post-mastectomy Breast Reconstruction)
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