Prepectoral Breast Reconstruction: Current Trends and Techniques

✍ Scribed by Raghavan Vidya (editor), Hilton Becker (editor)

• Publisher: Springer
• Year: 2023
• Tongue: English
• Leaves: 320
• Edition: 1st ed. 2023
• Category: Library

✦ Synopsis

Breast cancer is one of the most common forms of cancer worldwide, and surgery remains the mainstay of treatment. Breast reconstruction and Oncoplastic techniques have advanced over the last decade from complex autologous reconstruction to minimal invasive surgery. 

Breast reconstruction has evolved from traditional submuscular techniques to prepectoral implant-based reconstruction, thanks to advances in implantable biologic and synthetic products that make this muscle-sparing approach possible. In this state-of-the art volume, prominent clinicians and the pioneers of this technique join forces to provide the reader with a practical guide to prepectoral breast reconstruction, including relevant anatomical knowledge, key skills, and concrete tips for daily practice. After discussing the historical evolution of prepectoral breast reconstruction and providing an anatomical description of the superficial fascia system, the book presents the main approaches currently available, and addresses patient selection, radiation therapy, postoperative monitoring, and particular challenges such as revision surgery. Dedicated chapters on mesh scaffolds and autologous lipomodelling are also included. The book also features over 150 original full-color illustrations and drawings, together with take-home messages. With its complete yet handy format, Prepectoral Breast Reconstruction offers a valuable reference guide for residents, fellows, practicing breast surgeons, plastic surgeons, and all professionals in related sub-specialties.

 

✦ Table of Contents

Foreword
Preface
Acknowledgments
Contents
About the Editors
List of Videos
1: Evolution of Pre-Pectoral Breast Reconstruction
1.1 Introduction
1.2 Breast Implants
1.3 Acellular Dermal Matrix (ADM)
1.4 Mesh (ADMs) with Implants
1.5 Direct-to-Implant Pre-Pectoral Breast Reconstruction
1.6 Fat Grafting
1.7 Evolution of Pre-Pectoral Breast Reconstruction Timeline
1.8 Radiation
1.9 Benefits of Pre-Pectoral Breast Reconstruction
1.10 Complications Specific to Pre-Pectoral Breast Reconstruction
1.11 Conclusion
References
2: Anatomy of the Breast
2.1 Introduction
2.2 The Superficial Fascia System of the Breast
2.2.1 The Basic Body Segment
2.2.2 The Corpus Lamina
2.2.3 Anterior and Posterior Lamina
2.2.4 Circum-mammary Ligament
2.2.5 Circulation of the Breast
2.2.6 Lymphatic System of the Breast
2.2.7 Innervation of the Breast
2.3 Summary
References
3: Understanding Breast Cancer Oncology: The Need for Mastectomy and Axillary Staging
3.1 Introduction
3.2 Surgical Treatment of Breast Cancer: Historical Perspective
3.3 Indications for Mastectomy
3.4 Types of Mastectomies
3.5 Post-mastectomy Radiation Therapy
3.6 Management of the Axilla in Early-stage Breast Cancer
3.7 Downstaging the Axilla
3.8 Summary with Tips
References
4: Oncological Safety and Technical Advances in Skin and Nipple-Sparing Mastectomy
4.1 Introduction
4.2 History of Conservative Mastectomy
4.3 Surgical Technique
4.4 Complications
4.5 Oncological Safety: Review to Date
4.6 Cosmesis and Psychological Benefit
4.7 Conclusion
4.8 Summary with Tips
References
5: Prepectoral Breast Reconstruction: Selection Criteria and Patient Considerations
5.1 Introduction
5.2 Preoperative Selection Considerations
5.2.1 Patient Criteria
5.2.2 Tumor-Specific Considerations
5.3 Intraoperative Considerations
5.3.1 Intraoperative Assessment of Mastectomy Flaps
5.3.2 Cosmetic Considerations
5.4 Postoperative Considerations
5.4.1 Infection
5.5 Conclusion
References
6: Skin and Nipple-Sparing Mastectomy with Axillary Staging in Prepectoral Breast Reconstruction
6.1 Introduction
6.2 Skin and Nipple-sparing Mastectomy with Pre-Pectoral Breast Reconstruction: Surgical Planning
6.3 Pre-Operative Marking
6.4 Intraoperative Set-up
6.4.1 Skin-Sparing Mastectomy: Incision Placement
6.4.2 Nipple-Sparing Mastectomy: Incision Placement
6.4.3 Raising the Skin Flaps and Removing the Breast
6.4.4 Infection Prevention in Skin and Nipple-Sparing Mastectomy and Pre-Pectoral Breast Reconstruction
6.4.5 Axillary Staging in the Setting of Skin and Nipple-Sparing Mastectomy and PPBR
6.4.6 Sentinel Lymph Node Biopsy
6.4.6.1 Sentinel Lymph Node Identification Technique
6.4.6.2 Incision
6.4.6.3 Surgical Technique
6.4.7 Axillary Lymph Node Dissection
6.4.7.1 Incision
6.4.7.2 Surgical Technique
6.5 Summary with Tips
References
7: Importance of Tissue Perfusion and Assessment Methods of the Mastectomy Skin Flap
7.1 Background
7.2 Anatomy
7.3 Preoperative Planning
7.3.1 Patient-Specific Factors
7.3.2 Nipple-Sparing Mastectomy
7.3.3 Incision Design
7.4 Intraoperative Considerations
7.4.1 Mastectomy Flap Dissection
7.4.2 Mastectomy Flap Quality
7.5 Managing Compromised Flaps
7.5.1 Intraoperative Considerations
7.5.2 Postoperative Considerations
7.6 Conclusions
References
8: Meshes and Implants in Prepectoral Breast Reconstruction: Selecting the Right One
8.1 Introduction
8.2 Implant Selection
8.2.1 Silicone vs Saline
8.2.2 Textured vs Smooth
8.2.3 Round vs Anatomic
8.2.4 Cohesivity
8.2.5 Base Width
8.2.6 Implant Volume
8.3 Implant Manufacturers
8.3.1 Allergan
8.3.2 Sientra
8.3.3 Mentor
8.3.4 Silimed
8.3.5 Polytech
8.3.6 Ideal Implant
8.3.7 CG Aesthetics
8.3.8 Laboratories Arion
8.3.9 Hans Biomed
8.3.10 Ceraplas
8.3.11 Establishment Labs
8.3.12 Sebbin
8.3.13 Guangzhou Wanhe
8.3.14 CollPlant
8.4 Tissue Expanders
8.5 Mesh Selection
8.6 Biologic Meshes
8.6.1 Alloderm
8.6.2 Cortiva
8.6.3 Dermamatrix
8.6.4 FlexHD
8.6.5 Dermacell
8.6.6 SurgiMend
8.6.7 Strattice
8.6.8 Braxon
8.7 Synthetic Meshes
8.7.1 Absorbable Mesh
8.7.2 Galatea Scaffold
8.7.3 TIGR Matrix
8.7.4 SERI Surgical Scaffold
8.7.5 Permanent Mesh
8.7.6 TriLoop Bra
8.7.7 ULTRAPRO
8.7.8 SERAGYN
8.8 Surgical Tips
References
9: Prepectoral Implant-Based Breast Reconstruction: Complete Cover with Preshaped Mesh
9.1 Selection of Patients
9.2 Indications
9.3 Planning
9.4 Technique
9.5 Review of Literature
9.6 Summary and Tips
9.6.1 Preshaped Mesh
References
10: Prepectoral Implant-Based Breast Reconstruction with Anterior Implant Coverage
10.1 Introduction
10.2 Single-Stage Direct-to-Implant (DTI) or Two-Stage Reconstruction
10.3 Advantages and Disadvantages of Prepectoral Implant Placement
10.3.1 Disadvantages of Prepectoral Implant Placement
10.4 How to Cover the Implant
10.5 Technique of the Anterior Coverage of the Implant
10.6 Advancements in Technique and Materials
10.7 The Seroma Discussion
10.8 Prepectoral DTI Breast Reconstruction
10.9 Results
10.10 Prepectoral DTI in Large and Ptotic Breasts
10.11 Conclusion
References
11: Prepectoral Anterior Coverage Breast Reconstruction
11.1 Introduction
11.2 Anterior Coverage Versus Full Device Wrap?
11.3 Materials and Methods
11.4 Operative Procedure
11.5 Anterior Suturing Technique
11.6 Results
11.7 Discussion
11.8 Conclusion
References
Further Reading
12: Breast Reconstruction Using a Prepectoral Spacer
12.1 Procedure
12.2 Discussion
12.3 Poorly Vascularized Portions of the Flap Are Not Excised at the Time of the Mastectomy
12.4 Conclusion
References
13: Synthetic Meshes in Prepectoral Breast Reconstruction
13.1 Introduction
13.2 Patients’ Selection
13.3 Synthetic Meshes
13.4 Surgical Technique
13.5 Autologous Adipose Tissue Grafting
13.6 Complications
13.7 Review of Short Literature to Date
13.8 Summary with Tips
References
14: Hybrid Prepectoral Breast Reconstruction: Combining Flaps and Implants
14.1 Introduction
14.2 Timing of Implant Placement
14.3 Radiation Therapy
14.4 Plane of Implant Placement
14.5 Surgical Technique
14.6 Advantages of Hybrid Breast Reconstruction
14.7 Literature Review
14.8 Summary
References
15: Prepectoral Breast Reconstruction Without Mesh
15.1 Introduction
15.2 Indications and Contraindications
15.3 Surgical Technique
15.4 Clinical Outcomes
15.5 Considerations
15.6 Conclusions
References
16: Prepectoral Skin-Reducing Pattern
16.1 Introduction
16.2 Indications
16.3 Technique
16.3.1 Preoperative Drawing
16.3.2 Demolition Phase
16.3.3 Reconstruction Phase
16.4 Postoperative Care
16.5 Results and Complications
16.6 Review of Short Literature to Date
References
17: Complications: How to Reduce and Manage
17.1 Introduction
17.2 Type of Complications
17.3 Risk Factors for COMPLICACTION
17.4 Early Complications
17.4.1 Seroma
17.4.1.1 Prevention
Suction Drainage
Quilting Suture
Tissue Sealants
Surgical Cutting Devices
Axillary Dissection Technique
Avoidance of Active Shoulder Mobilization
External Soft Compression
17.4.1.2 Management
17.4.2 Hematoma
17.4.2.1 Prevention
17.4.2.2 Management
17.4.3 Skin/Nipple–Areola Complex Necrosis
17.4.3.1 Prevention
17.4.3.2 Management
17.4.4 Infection
17.4.4.1 Prevention
17.4.4.2 Management
17.4.5 Wound Dehiscence
17.4.5.1 Prevention
17.4.5.2 Management
17.4.6 Red Breast Syndrome
17.4.6.1 Prevention and Management
17.4.7 Implant Extrusion
17.5 Late Complications
17.5.1 Capsular Contracture
17.5.1.1 Prevention
17.5.1.2 Management
17.5.2 Implant Displacement
17.5.2.1 Prevention
17.5.2.2 Management
17.5.3 Rippling
17.5.3.1 Prevention
17.5.3.2 Management
17.5.4 Visible Implant Edge
17.6 Conclusion
References
18: Clinical, Histological, and Ultrasound Follow-Up of Breast Reconstruction with One-Stage Prepectoral Breast Reconstruction
18.1 Introduction
18.2 Main Manuscript
18.3 Clinical Follow-Up
18.4 Histological Follow-Up
18.5 Ultrasound Follow-Up
18.6 Review of Short Literature to Date
18.7 New Generation ADMs: Three-Dimensional Matrices
18.8 New Generation ADMs: Matrices with Adipogenic Stimulus
18.9 Summary with Tips
References
19: Prepectoral Implants and Radiation Therapy
19.1 Introduction
19.2 Role of Postmastectomy Radiation
19.3 Radiation Target and Technique
19.4 Radiation Fractionation
19.5 Types of Breast Reconstruction and Radiation
19.6 Types of Expander and Radiation Therapy
19.7 Types of Mastectomies and Radiation Therapy Timing
19.8 Conclusion
References
20: Planning Pre-pectoral Implant-Based Breast Reconstruction When Confronted with XRT
20.1 Introduction
20.2 Radiotherapy (XRT)
20.2.1 The Need
20.2.2 Improvements of Radiation Throughout the Years
20.2.3 Classification of Tissue Damage
20.2.4 XRT Before Reconstruction
20.3 Pre-pectoral Reconstruction in Face of XRT Before the Reconstruction
20.3.1 Why?
20.3.2 Advantages as Compared with Sub-pectoral
20.3.3 XRT After Reconstruction
20.3.4 Influence on the Tissues
20.3.5 Pre-pectoral Reconstruction in the Face of Expected XRT After Reconstruction
20.3.6 Two-Stage vs. One-Stage Reconstruction
20.4 Summary
20.5 Review of Short Literature to Date Summary with Tips
20.5.1 Tips
References
21: Fat Grafting for Volume Augmentation in Prepectoral Breast Reconstruction
21.1 Introduction
21.2 Operative Technique
21.3 Discussion
21.4 Summary
References
22: The LOTUS Pre-pectoral Breast Reconstruction
22.1 Introduction
22.1.1 Minimally Invasive Mastectomy
22.1.2 LOTUS Breast Reconstruction
22.2 Results
22.2.1 Recommended Post Reconstruction Surveillance
22.2.2 Reconstruction Outcome Grading
22.2.3 Conclusions
References
23: Endoscopic-Assisted Nipple and Skin Sparing Mastectomy
23.1 Introduction
23.2 Detailed Technique Description [16]
23.2.1 Positioning and Sentinel Lymph Node Biopsy
23.2.2 Skin Incision for E-NSM
23.2.3 Posterior Plane Dissection
23.2.4 Skin Flap Dissection
23.2.5 Single Port Air Inflation or Retraction Type E-NSM
23.2.6 Sub-nipple Biopsy
23.2.7 Subpectoral Prothesis Breast Reconstruction
23.3 Current Evidence on Endoscopic-Assisted Nipple and Skin Sparing Mastectomy in Terms of Indications, Techniques, and Outcome Measures (Table 23.1) [17]
23.3.1 Indication for E-NSM [7, 15, 16]
23.3.2 Technique Refinements of E-NSM
23.3.3 Aesthetic Outcome
23.4 Discussion
23.4.1 Dual Incision
23.4.2 Single Axillary Incision Hybrid E-NSM [15]
23.4.3 Insufflation Technique [6, 15, 16]
23.4.4 3-Dimensional (3D) Imaging [16]
23.4.5 Other Advancements in Endoscopic-Assisted Breast Surgery: Robotic-Assisted Nipple Sparing Mastectomy
23.4.6 Implant Reconstruction with Endoscopic-Assisted Mastectomy: Subpectoral vs Pre-pectoral Implant Placement
23.5 Conclusion
References
24: The Functional and Cost-Effectiveness of Prepectoral Breast Reconstruction
24.1 Functional Evaluation of Prepectoral ADM-Assisted Breast Reconstruction
24.1.1 Introduction
24.1.2 Background of Breast Reconstruction
24.1.3 Notes of Chest Wall Area Functional Anatomy
24.1.4 Subjective Validated Tests to Evaluate Upper Limb Function
24.1.5 Objective Validated Tests to Evaluate Upper Limb Function
24.1.6 Functional Impact of Breast and Reconstructive Surgery
24.1.7 Pro-active Physiotherapist Approach
24.1.8 Functional Advantages of Prepectoral Breast Reconstruction
24.2 Economic Evaluation of Prepectoral ADM-Assisted Breast Reconstruction
24.2.1 Introduction
24.2.2 Causes of a Suboptimal Rate of Breast Reconstruction
24.2.2.1 Availability of Various Approaches to Breast Reconstruction
24.2.2.2 Acceptability of Breast Reconstruction
24.2.3 Bases of the Economical Evaluation
24.2.3.1 Operative Time
24.2.3.2 Duration of Hospitalization
24.2.3.3 Pain and the Need for Analgesics
24.2.3.4 Physical and Functional Integrity
24.2.3.5 Normal Activity Recovery Time
24.2.3.6 Stability of the Reconstructed Breast and Need for Revision Surgery
24.2.3.7 Aesthetic Outcome and Patient Satisfaction
24.2.4 In-Hospital Costs
24.2.5 Monetary Evaluation of Outcomes
24.3 Conclusion
24.4 Summary with Tips
References
25: Prepectoral Breast Reconstruction Using a Bio-Synthetic Scaffold
25.1 Introduction
25.2 Procedure
25.2.1 Results
25.3 Discussion
25.4 Conclusion
References
Index