Safe and Efficient Implant-based Breast Reconstruction

Abstract

Implant-based breast reconstruction is a safe and effective option associated with high patient satisfaction. Techniques have evolved significantly over the past several decades, characterized mostly by a reduction in the number of stages and time required to complete reconstruction, with maximal preservation of native breast elements. Nevertheless, both old and new techniques of implant-based breast reconstruction have a role depending on the specific clinical scenario, and thus plastic surgeons should be well versed in the full spectrum of options. This article reviews the key considerations underlying decision-making in implant-based breast reconstruction and the most effective techniques, with a focus on optimizing safety and efficiency.

Fig. 1.

Intraoperative photograph demonstrating tissue expander placement beneath the pectoralis major muscle and the serratus anterior fascia. IMF, inframammary fold; TE, tissue expander. Adapted with permission from Plast Reconstr Surg. 2010;125:1057–1064.

Fig. 2.

Intraoperative photograph demonstrating inset of the anterior border of the serratus anterior fascia to the lateral border of the pectoralis major muscle to achieve total coverage of the tissue expander. IMF, inframammary fold. Adapted with permission from Plast Reconstr Surg. 2010;125:1057–1064.

Fig. 3.

Intraoperative photograph demonstrating dual-plane implant placement beneath the pectoralis major muscle and ADM. Adapted with permission from Plast Reconstr Surg. 2012;130:44S–53S.

Fig. 4.

Two sheets of ADM are draped over the tissue expander to achieve a smooth contour. Adapted with permission from Plast Reconstr Surg. 2017;140:51S–59S.

Fig. 5.

The tissue expander position is secured by utilizing its suture tabs to the underlying pectoralis major muscle. Adapted with permission from Plast Reconstr Surg. 2017;140:51S–59S.