“Two years ago…I had no breasts. I lived with this for seven months from the time of my double mastectomy to my reconstruction. The psychological impact on me personally was devastating. There have been studies shown that many women go through this same detriment when losing their breasts to breast cancer. That study along with speaking to other women weighed heavy on my heart both intellectually and emotionally. I wanted to change that for others, pay it forward, if you will.”
-Terri Coutee, Founder & Director “DiepCFoundation”1
After surviving breast cancer and undergoing mastectomy, some women are often left with psychological problems, poor self-esteem, diminished sexual well-being, and decreased overall quality of life.2 For those women, breast reconstruction is a vital surgical procedure. Many courageous women I have met through my practice and through the Alliance in Reconstructive Surgery (AiRS) foundation report that their breast reconstructions following mastectomy were truly life-changing and life-saving. “I could be restored to a place in my womanhood that had been removed,” one patient reported.3 Not all women want or need to have breast reconstruction following mastectomy, but—in the light of studies that have shown that “many women eligible for breast reconstruction following breast cancer, minorities in particular, are not informed of the variety of care options”4—the plastic and reconstructive community works diligently within the public sector5 and researches demographic trends6,7 in data in pursuit of universal knowledge and access to reconstructive options. In order to ensure that all breast cancer survivors and mastectomy patients can have access to the safest, most efficacious, and least complicated breast reconstruction procedures possible if they so choose, plastic surgeons in clinics, laboratories, and universities across the world are continually conducting research and studies to advance the science of breast reconstruction.
As a special update on the most recent cutting-edge research, practice improvements, and developments in this important field of study in plastic surgery, I proudly present to you this special supplement to Plastic and Reconstructive Surgery on Advances in Breast Reconstruction. This supplement is meant to prime our readers on the latest developments in this area, including current trends, oncoplastic surgery, radiation, the evolution of tissue expanders, and acellular dermal matrices. Additionally, the supplement discusses nipple-sparing mastectomy and a variety of breast reconstruction surgical advancements including direct-to-implant, fat grafting, prepectoral reconstruction, and lower extremity–based free flaps. I hope you will find the Advances in Breast Reconstruction Supplement before you today intriguing, educational, and stimulating.
The techniques presented in this supplement to Plastic and Reconstructive Surgery do not necessarily represent best practices or endorsed techniques of the Guest Editors, Editor-in-Chief, Editorial Board, American Society of Plastic Surgeons (ASPS) or Wolters Kluwer Health. Publication of these supplements does not constitute product or sponsor endorsement by this Journal or the ASPS. None of the materials contained in this supplement are considered to be practice guidelines or best medicine protocols but are merely the authors’ collective experience and expertise in the proscribed area. These articles and videos represent state-of-the-art studies, in-depth reviews, and personal operative techniques of the authors and have been rigorously peer-reviewed and revised prior to acceptance.
I am very appreciative for the responsiveness, commitment, enthusiasm, and leadership of this supplement’s guest editors, Amy S. Colwell, MD, Joseph J. Disa, MD, and John Y.S. Kim, MD, who bring their understanding of innovative studies and practical experience with multi-institutional long-term research to fruition in this supplements. These 3 breast reconstruction surgeons, researchers, and study authors combined their thirst for knowledge, desire for improved patient education and outcomes, and their years of clinical experience to bring you this important update on the cutting edge of breast reconstruction today.
I am also very thankful for recognizing the group of expert plastic and reconstructive surgeons who volunteered their time and energy to write these articles, as well as those who served as peer reviewers. Their dedication, persistence, and flexibility are enviable; we would not have this supplement before you today without their contributions and efforts.
This supplement was made possible by unrestricted educational from Allergan, Mentor Worldwide LLC, MTF Biologics, and Sientra, Inc. On behalf of the ASPS Executive Committee, the PRS and PRS Global Open Managing Committee, and the PRS Editorial Board, I offer genuine gratitude for the generosity of these supporters. I am thankful for their commitment to helping us disseminate breast reconstruction research, advances, and education far and wide. The content of the supplement was not dictated or influenced by the sponsors, and all financial declarations/affiliations of the authors have been intentionally and redundantly disclosed and printed in this supplement.
I am grateful to our publishing team at Wolters Kluwer Health and to the exceptional Editorial Office team, especially Editorial Assistant Christina Carson and Senior Managing Editor Aaron Weinstein. The Editorial team’s reliability, proficiency, and creativity continually make Plastic and Reconstructive Surgery the number 1 plastic surgery journal in the world.
In honor of the 70th anniversary of PRS in 2016, I mused upon what the field of plastic surgery might look like in another 70 years, in 2086. I wrote “it is our firm home that by 2086 the scientific community will have won, or at least be winning, the war on cancer. It would be our specialty’s fondest pleasure to no longer have to perform any breast reconstructions following cancer.”8 We will relish the day when mastectomies and postcancer breast reconstruction are merely artifacts of the past. Until that day, however, plastic and reconstructive surgeons will continue to research and write and advance the science of breast reconstruction through studies and supplements like the one you are reading today. We pursue the advancement of breast reconstruction to continually improve the safety, outcomes, and care of women completing their battles with breast cancer through reconstruction.
“Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.” 9
- Angelina Joile, Actress and Director, discussing her double mastectomy and breast reconstruction
2. Zhong T, Hu J, Bagher S, et al. A comparison of psychological response, body image, sexuality, and quality of life between immediate and delayed autologous tissue breast reconstruction: a prospective long-term outcome study. Plast Reconstr Surg. 2016;138:772–780.
6. Kamali P, Zettervall SL, Wu W, et al. Differences in the reporting of racial and socioeconomic disparities among three large National Databases for Breast Reconstruction. Plast Reconstr Surg. 2017;139:795–807.
7. Sharma K, Grant D, Parikh R, et al. Race and breast cancer reconstruction: is there a health care disparity? Plast Reconstr Surg. 2016;138:354–361.
8. Rohrich R, Weinstein A. “Plastic and reconstructive surgery: the future of the journal and the field through the 21st century.” Plast Reconstr Surg. 2016;138:318–324.