Clinical Approaches to Breast Reconstruction: What Is the Appropriate Reconstructive Procedure for My Patient?

Abstract

Breast reconstruction after breast cancer is an emotional subject for women. Consequently, the correct timing and surgical procedure for each individual woman are important. In general, heterologous or autologous reconstructive procedures are available, both having advantages and disadvantages. Breast size, patient habitus, and previous surgeries or radiation therapy need to be considered, independent of the chosen procedure. New surgical techniques, refinement of surgical procedures, and the development of supportive materials have increased the general patient collective eligible for breast reconstruction. This review highlights the different approaches to immediate breast reconstruction using autologous or heterologous techniques.

Keywords: Acellular dermal matrix; Autologous breast reconstruction; Breast reconstruction; Heterologous breast reconstruction; Mesh.

Fig. 1

41-year-old patient with multifocal invasive lobular carcinoma, left breast. Skin-sparing mastectomy with subpectoral direct-to-implant breast reconstruction (Allergan Style 410LL, 135 g). 2 weeks postoperatively.

Fig. 2

Intraoperative view of a skin-sparing mastectomy, right side, using an inverted T incision. An inferior dermal flap (a) was resected for additional support and sutured to the inferior pole of the pectoralis major muscle (b). No mesh or acellular dermal matrices needed.

Fig. 3

a Breast cancer, right breast, with nipple-sparing mastectomy 11/2009. No postoperative radiotherapy; development of capsular fibrosis. b Subpectoral implant exchange und adjusting reduction mammoplasty to the contralateral side 07/2011. c Appealing long-term result 07/2014.

Fig. 4

a 57-year-old patient with large ductal carcinoma in situ, left breast, before surgery. b 6 months after skin-sparing mastectomy using an inverted T incision, preparation of an infero-dermal flap for subpectoral direct-to-implant reconstruction (Allergan Style 410MM, 400 g). Simultaneous contralateral adjustment of the right breast. Wound revision first postoperative day, right breast, due to bleeding.

Fig. 5

a 42-year-old patient with multifocal breast cancer, left breast, before surgery. b 8 months after nipple-sparing mastectomy with immediate latissimus dorsi flap reconstruction, left breast. No implant.

Fig. 6

53-year-old patient after radical mastectomy and chemotherapy, right breast. a Before surgery; b 5 days after surgery.