Implant-Based Breast Reconstruction: Hot Topics, Controversies, and New Directions-Implant-Based Breast Reconstruction: Hot Topics, Controversies, and New Directions

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Implant-based breast reconstruction is currently the most common method used in the United States and is evolving with new techniques and technologies aimed at improving patient outcomes. Common methods include one-stage or two-stage reconstructions, often involving the use of temporary tissue expanders followed by permanent implants. Safety profiles, complication rates, and patient satisfaction are continually being studied, with findings suggesting that both one-stage and two-stage techniques can be effective depending on patient selection and specific conditions.<br /><br />There are ongoing discussions in the field about various aspects of the reconstruction process, like whether to use muscle or scaffold to cover the implant, and the advantages of different implant types (smooth vs. textured). Scaffolds such as acellular dermal matrices can offer specific benefits but also come with increased risk of complications. Prepectoral placement of implants is a newer technique that seeks to reduce some negative outcomes of submuscular placements, although it may require specific patient criteria to ensure safety and efficacy.<br /><br />Another major consideration is the timing and method of radiotherapy in patients undergoing reconstruction, particularly how it affects the longevity and success of the reconstruction. Antibiotic prophylaxis remains a critical factor, and the duration and type of prophylaxis are subjects of ongoing study. <br /><br />Nipple-sparing mastectomy is a recent advancement offering improved aesthetic and patient satisfaction outcomes without compromising oncologic safety for certain patients. However, specific patient risk factors need to be carefully considered.<br /><br />Prepectoral breast reconstruction, which involves placing the implant above the pectoral muscle, is gaining popularity due to its potential advantages in reducing pain and improving aesthetic outcomes. Patient-controlled tissue expansion devices are also being developed to reduce the disadvantages of traditional expanders.<br /><br />Finally, alloplastic reconstruction is constantly advancing, and plastic surgeons are expected to stay informed about these developments to provide the best evidence-based care for their patients.

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Author(s): Frey, Jordan D. M.D.; Salibian, Ara A. M.D.; Karp, Nolan S. M.D.; Choi, Mihye M.D. Learning Objectives:After studying this article, the participant should be able to: 1. Evaluate appropriate patients best suited for one- or two-stage alloplastic breast reconstruction. 2. Discuss and apply the unique advantages and disadvantages of scaffold use and different implant types in breast reconstruction to maximize outcomes. 3. Develop a plan for patients undergoing implant-based breast reconstruction requiring postmastectomy radiation therapy. 4. Analyze the evidence with regard to antibiotic prophylaxis in implant-based breast reconstruction. 5. Recognize and critique novel technical and device developments in the field of alloplastic breast reconstruction, enabling appropriate patient selection. Summary:Implant-based, or alloplastic, breast reconstruction is the most common method of breast reconstruction in the United States. Within implant-based reconstruction, many techniques and reconstructive strategies exist that must be tailored for each individual patient to yield a successful reconstruction. Not unexpectedly, many hot topics and controversies in this field have emerged, including stages of reconstruction, use of scaffolds, permanent implant type, strategies for postmastectomy radiation therapy, and antibiotic prophylaxis. In addition, there has been an evolution in technical and device development in recent years. Therefore, plastic surgeons must be on the forefront of knowledge to approach implant-based breast reconstruction in an evidence-based fashion to best treat their patients. Plastic and Reconstructive Surgery: February 2019 - Volume 143 - Issue 2 - p 404e-416e doi: 10.1097/PRS.0000000000005290

Keywords

Jordan D. Frey MD; Ara A. Salibian MD; Nolan S. Karp MD; Mihye Choi MD; Memben

breast reconstruction

implant-based

one-stage reconstruction

two-stage reconstruction

tissue expanders

prepectoral placement

acellular dermal matrices

nipple-sparing mastectomy

radiotherapy

patient satisfaction