10 - Immediate Two-Stage Implant-Based Breast Reconstruction With Acellular Dermal Matrix

Abstract

Immediate two-stage prosthetic breast reconstruction is well accepted in breast cancer reconstruction due to its impact on post-mastectomy body image and quality of life, as well as its safety and high patient satisfaction. Key indications for immediate breast reconstruction include the patient's oncologic disease burden as well as the need for adjuvant therapy. Immediate two-stage implant-based reconstruction is optimal in cases where adjuvant radiation therapy is not required. However, the success and outcome of immediate implant-based reconstruction depends heavily on a reliable native soft tissue envelope. The two-stage approach also allows for precise recreation of the breast mound in terms of Infra-mammary fold positioning, natural shape, and final symmetry and is more flexible than one-stage implant-based reconstruction with fewer complications. In this chapter, the authors will focus on tissue expander–based immediate breast reconstruction with acellular dermal matrix (ADM) as a first-stage implant-based breast reconstruction. Emphasis will be placed on surgical technique, as well as highlighting key concepts and pearls in tissue expander/ADM-based reconstruction.