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Two-Stage Implant-Based Breast Reconstruction: An Evolution of the Conceptual and Technical Approach over a Two-Decade Period

Cordeiro, Peter G., M.D.; Jazayeri, Leila, M.D.

Plastic and Reconstructive Surgery: July 2016 - Volume 138 - Issue 1 - p 1-11
doi: 10.1097/PRS.0000000000002243
Breast: Original Articles
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Background: Over a two-decade period, the senior author (P.G.C.) has had extensive experience with two-stage implant-based breast reconstruction with total musculofascial coverage. During this period, the approach has evolved substantially. The evolution has been based on changes in breast cancer treatment, available technology and, most importantly, yearly evaluation of surgical outcomes.

Methods: This article describes changes in the conceptual approach to breast reconstruction, and the resulting evolution of surgical techniques. Evolving concepts and current techniques are described as they relate to each consecutive stage of implant-based breast reconstruction.

Results: For the first stage of breast reconstruction (i.e., placement of the tissue expander), key concepts and techniques described are the vertical mastectomy defect, the point of maximal expansion, the musculofascial pocket, and the inferior fasciotomy. For the second stage of breast reconstruction (i.e., the exchange procedure), key concepts and techniques described are implant selection, setting the inframammary fold, defining the inferolateral shape of the breast, and circumferential capsulotomy.

Conclusion: The purpose of this article is to relay the lessons learned from this long experience and to provide a conceptual and technical framework to two-stage implant-based breast reconstruction.

New York, N.Y.

From the Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center.

Received for publication April 30, 2015; accepted February 10, 2016.

Disclosure:Dr. Cordeiro receives financial and material support from Allergan for participation in a multicenter clinical research study. Dr. Jazayeri has no financial interests or commercial associations to disclose.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Videos” tab to watch. On the iPad, tap on the Hot Topics icon.

Peter G. Cordeiro, M.D., Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, N.Y. 10065

Copyright © 2016 by the American Society of Plastic Surgeons