New perspectives in breast reconstruction

Skin sparing and nipple sparing mastectomies allow breast surgeons to preserve the breast envelope in patients affected by breast cancer without direct involvement of the skin or the nipple areola complex, respectively (1). Immediate breast reconstruction provides women undergoing mastectomy for both breast cancer treatment and risk reduction significant psychological benefit (2).

Nowadays, many techniques for breast reconstruction are available. These include both the use of alloplastic materials (i.e., breast implants) and autologous tissue (3). Implant-based techniques remain the most widely used form of breast reconstruction (4).

New techniques, materials and devices are currently available to improve aesthetic outcomes. Examples of such new technologies are acellular dermal matrices (ADMs), synthetic meshes and autologous fat grafting (5).

The use of these devices and ancillary techniques not only improves breast volume and shape but also changes the host tissue response to foreign implants with significant advantages in terms of post-operative complications and stability of the aestethic result (6).

In the future the implementation of a 3D-printed scaffold, based on pre-operative imaging, colonized with autologous fat, may further improve aesthetic outcomes (7).

A total replacement of the implants with autologous fat would be desirable but it’s not realistic at the moment. While waiting for new technologies to replace old ones, a “hybrid breast reconstruction model”, in which implants, ADMs, synthetic meshes and fat grafting are used as integrated tools is used (6). In this model fat grafting planned pre-operatively as part of the reconstruction, both with the sub-pectoral and pre-pectoral approach. The final breast volume constitutes of fat and of an implant in a variable percentage according to the patient body contour and breast morphology.

The hybrid approach could be applied to both pre-pectoral and sub-pectoral implant-based breast reconstructions. The pre-pectoral approach has recently gained wide acceptance among breast oncoplastic surgeons thanks to the excellent surgical outcomes obtained in properly selected patients, also showing a reduced complication rate in women undergoing post-mastectomy radiotherapy (8).

Here we present a series of articles describing the latest developments in breast reconstruction. Taher et al. (9) and Saibene et al. (10) discussed the role of pre-pectoral implant-based breast reconstruction in improving outcomes in the setting of post-mastectomy radiotherapy using or not ADMs. Esposito et al. (11) presented the outcomes on new surgical approaches for implant-based breast reconstruction as the trans-axillary endoscopic one. Di Micco et al. (12) and Velotti et al. (13) presented the latest evidence on pre-pectoral implant-based breast reconstruction. Gonzalez et al. (14) presented the outcomes of immediate fat grafting following breast conserving surgery and Rancati et al. (15) a new technique for the immediate reconstruction of the nipple-areola complex over the latissimus dorsi skin paddle in autologous reconstruction.

We hope you will enjoy reading about the constantly evolving field of breast reconstruction.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Breast Surgery for the series “New Perspectives in Breast Reconstruction”. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://abs.amegroups.org/article/view/10.21037/abs-23-39/coif). The series “New Perspectives in Breast Reconstruction” was commissioned by the editorial office without any funding or sponsorship. N.R. served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Annals of Breast Surgery from April 2023 to March 2025. G.C. and G.M. served as the unpaid Guest Editors of the series. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

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15. Rancati A, Angrigiani C, Dorr J, et al. Immediate nipple areolar complex reconstruction over latissimus dorsi skin paddle flap in bilateral periareolar mastectomy & reconstruction. Ann Breast Surg 2023;7:36. [Crossref]

Nicola Rocco

Giuseppe Catanuto

Giacomo Montagna