Updates on Breast Reconstruction: Surgical Techniques, Challenges, and Future Directions

Abstract

The increasing global incidence of breast cancer underscores the significance of breast reconstruction in enhancing patients' quality of life. Breast reconstruction primarily falls into two categories: implant-based techniques and autologous tissue transfers. In this study, we present a comprehensive review of various aspects of implant-based reconstruction, including different types of implants, surgical techniques, and their respective advantages and disadvantages. For autologous breast reconstruction, we classified flaps and optimal harvest sites and provided detailed insights into the characteristics, benefits, and potential complications associated with each flap type. In addition, this review explores the emerging role of fat grafting, which has received increasing attention in recent years. Despite advancements, there remains substantial scope for further improvements in breast reconstruction, emphasizing not only aesthetic outcomes, but also a reduction in complications and postoperative recovery. By offering a comprehensive overview of the historical evolution, current landscape, and future prospects of breast reconstruction, this review aims to provide readers with a comprehensive understanding of breast cancer management strategies.

Keywords: Autologous breast reconstruction; Breast implant; Breast reconstruction; Fat grafting.

Figure 1

Types of implants and anatomical planes of reconstruction. This figure shows a flowchart of implant types and anatomical planes. In terms of contents, silicone implants are preferred for their softness, while smooth implants are favored due to concerns about breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). For the anatomical plane, the prepectoral option is chosen when the mastectomy flap has sufficient thickness. The use of acellular dermal matrix (ADM) is required in the prepectoral plane.

Figure 2

Subpectoral reconstruction. The tissue expander (TE) is inserted into the subpectoral plane. After several months of percutaneous saline infusion and gradual expansion, the TE will be replaced with the breast implant.

Figure 3

Subpectoral reconstruction with acellular dermal matrix (ADM). The pectoralis major muscle is detached inferiorly, and then sutured to the ADM to create a single plane. This eliminates the need for expanding the pectoralis major muscle using a tissue expander (TE), allowing for the implant to be inserted in a single phase.

Figure 4

Prepectoral reconstruction. The breast implant is entirely covered with acellular dermal matrix (ADM) and inserted at the anterior aspect of pectoralis major muscle. This method is less invasive and becoming more widely used.

Figure 5

Representative examples of flaps used in autologous breast reconstruction. The LDMC flap is a pedicled myocutaneous flap, while the others are free perforator flaps that require vascular anastomoses. LDMC flap: latissimus dorsi myocutaneous flap; DIEP flap: deep inferior epigastric artery perforator flap; LAP flap: lumber artery perforator flap; PAP flap: profunda artery perforator flap; GAP flap: gluteal artery perforator flap.