20 - Implant-based breast reconstruction

Abstract

▪Alloplastic breast reconstruction is the most common approach used today for postmastectomy breast reconstruction.▪Traditional breast implant reconstruction is performed as a planned two-stage procedure with the use of a tissue expander followed by exchange to a breast implant.▪Changing demographics of the mastectomy patient, improved devices and support matrices, as well as refinements in mastectomy techniques have allowed for expanded indications of direct-to-implant breast reconstruction.▪Enhanced collaboration between oncologic surgeons and plastic surgeons is necessary in order to maximize outcomes in immediate breast reconstruction.▪Increasing awareness of the indications for skin and nipple preservation together with improved devices, internal scaffolds, and judicious use of fat transfer allow for results that may approximate the appearance and feel of a natural non-operated breast.▪Nipple-sparing mastectomy is increasingly performed for treatment or prevention of breast cancer.▪Key points of the history and physical exam determine if the patient is a candidate for nipple preservation.▪Reconstructive goals include rebuilding the breast with nipple centralization.▪Outcomes data show excellent results in cosmesis and complication rates.