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State of the Art and Science in Postmastectomy Breast Reconstruction

Kronowitz, Steven J. M.D.

Plastic and Reconstructive Surgery: April 2015 - Volume 135 - Issue 4 - p 755e–771e
doi: 10.1097/PRS.0000000000001118
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Learning Objectives: After reading this article, the participant should be able to: 1. Examine clinicopathologic factors to determine the best timing for breast reconstruction. 2. Develop treatment plans for all patients for breast preserving reconstruction. 3. Determine the best approaches for partial and whole breast reconstruction. 4. Be familiar with advanced techniques in breast reconstruction.

Background: Often, the decision to perform a partial or total mastectomy hinges on reconstructive issues, not oncology-related considerations.

Methods: Innovative timing and reconstruction approaches are being implemented after partial mastectomy and breast reconstruction after mastectomy.

Results: Among patients undergoing repair of a partial mastectomy defect, immediate or delayed repair before radiation allows for use of remaining breast tissue for repair. Innovative approaches include breast remodeling, local rotation advancement, and concentric mastopexy and breast reduction techniques to recontour remaining breast tissue. Delayed repair after whole-breast radiation usually is not preferred and is performed with autologous fat grafting or a flap. However, partial breast radiation allows for safe delayed repair after irradiation using the same techniques used for preradiation repair. The optimal timing for breast reconstruction after mastectomy remains a topic of controversy. Adjunct techniques for implant-based postmastectomy reconstruction include the use of acellular dermal matrix and autologous fat grafting, especially in the setting of radiation therapy. Techniques also include a more focused use of flaps only in the setting of radiation therapy with increasing use of new perforator-based autologous tissue flap options.

Conclusion: Innovative approaches to breast reconstruction have evolved to provide restorative healing for patients and hasten return to their modern, active lifestyles.

Related Video Content is available online for this article.

Houston, Texas

From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center.

Received for publication August 30, 2014; accepted January 2, 2014.

Disclosure: The author has no financial interest to declare in relation to the content of this article.

Related Video content is available for this article. The videos can be found under the “Related Videos” section of the full-text article, or, for Ovid users, using the URL citations published in the article.

Steven J. Kronowitz, M.D., Department of Plastic Surgery, Unit 443, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, skronowi@mdanderson.org

©2015American Society of Plastic Surgeons