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Breast Reconstruction: Clinical Updates and Perspectives
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Breast Reconstruction: Clinical Updates and Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 15 May 2024 | Viewed by 3825

Special Issue Editor

Prof. Dr. Pietro G. Di Summa

E-Mail Website
Guest Editor
Associate Professor, Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
Interests: breast microsurgery; breast cancer-related lymphedema; implant-based breast reconstruction; aesthetic breast surgery; fat grafting
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Breast reconstruction represents an exciting field of plastic surgery innovation, with a critical role in patient well-being.

Microsurgical reconstruction of the breast has become a routine procedure in most hospitals, proving to be time and cost-effective. Attention has been placed on limiting donor site morbidity and enhancing the aesthetic appearance of the breast, eventually combining multiple flaps to achieve the ideal volume and desired shape. In the case of breast cancer-related lymphedema, the combination of lymph node flaps with breast flaps has further pushed the level of reconstruction towards complete anatomical restoration. Advancements have followed on the oncologic side, with increased quality of nipple-sparing mastectomies in the constant search for a natural aspect of the reconstructive breast.

The same impressive pace has been seen in implant-based reconstruction. Particularly, direct-to-implant reconstruction has become a popular way of breast reconstruction, even in previously “off-limits” radiotherapy scenarios. Prepectoral implant reconstruction has raised attention for its non-invasiveness and fat graft confirms to be an invaluable resource for refining reconstructive outcomes.

This Special Issue of the highly impacted Journal of Clinical Medicine, “Breast Reconstruction: Clinical Updates and Perspectives” wants to give not only an update on the latest techniques but also critically analyze their effectiveness and complications, to guide the plastic surgeon for the best possible decision making in breast reconstruction.

Prof. Dr. Pietro G. Di Summa
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • breast microsurgical reconstruction
  • stacked and combined flaps
  • implant-based reconstruction
  • breast cancer-related lymphedema
  • direct-to-implant reconstruction
  • prepectoral breast reconstruction

Published Papers (4 papers)

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Editorial

Jump to: Research, Review

3 pages, 158 KiB  
Editorial
Artistry and Aesthetics in Breast Reconstruction: Raising the Bar
by Pietro Giovanni di Summa and Gianluca Sapino
J. Clin. Med. 2023, 12(13), 4459; https://doi.org/10.3390/jcm12134459 - 03 Jul 2023
Viewed by 733
Abstract
Breast reconstruction is a critical component of breast cancer treatment for many women who undergo mastectomy [...] Full article
(This article belongs to the Special Issue Breast Reconstruction: Clinical Updates and Perspectives)

Research

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13 pages, 2828 KiB  
Article
Buried Autologous Breast Reconstruction: Outcomes and Technical Considerations
by Henrietta Creasy, Isabelle Citron, Timothy P. Davis, Lilli Cooper, Asmat H. Din and Victoria Rose
J. Clin. Med. 2024, 13(5), 1463; https://doi.org/10.3390/jcm13051463 - 02 Mar 2024
Viewed by 606
Abstract
The purpose of this study is to compare outcomes in patients undergoing buried and non-buried free flaps for breast reconstruction, in addition to evaluating the safety and reliability of venous flow couplers. A retrospective review was performed of all patients undergoing free flap [...] Read more.
The purpose of this study is to compare outcomes in patients undergoing buried and non-buried free flaps for breast reconstruction, in addition to evaluating the safety and reliability of venous flow couplers. A retrospective review was performed of all patients undergoing free flap breast reconstruction between 2013 and 2023. The primary outcomes were free flap failure, complications and the number of procedures required to complete the reconstructive journey. A total of 322 flaps were performed in 254 consecutive patients, with 47.5% (n = 153) being buried and 52.0% (n = 169) being non-buried reconstructions. The most common flap of choice being deep inferior epigastric artery perforator flaps (81.9%) followed by profunda artery perforator flaps (14.3%). There was no significant difference between the two groups in complications, including flap failure (buried 2.0% vs. non-buried 1.8% p = 0.902). There was a significant reduction in the number of procedures required to complete the reconstructive journey, with 52.2% (n = 59) of patients undergoing single-stage breast reconstruction in the buried group compared with only 25.5% (n = 36) in the non-buried group (p < 0.001). Two (0.6%) patients experienced a false negative in which the signal of the flow coupler was lost but the flap was perfused during re-exploration. No flap losses occurred without being identified in advance by a loss of audible venous flow signal. Buried free flap breast reconstruction is safe and requires fewer operations to complete patients’ reconstructive journey. Flow couplers are a safe and effective method of monitoring buried free flaps in breast reconstruction. Full article
(This article belongs to the Special Issue Breast Reconstruction: Clinical Updates and Perspectives)
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Review

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12 pages, 625 KiB  
Review
Impact of Adjuvant Radiotherapy on Free Flap Volume in Autologous Breast Reconstruction: A Scoping Review
by Pablo Pfister, Seraina L. C. Müller, Anna-Lena Eberhardt, Medea Rodriguez, Nadia Menzi, Martin Haug, Dirk J. Schaefer, Elisabeth A. Kappos and Tarek Ismail
J. Clin. Med. 2024, 13(1), 217; https://doi.org/10.3390/jcm13010217 - 29 Dec 2023
Viewed by 887
Abstract
In autologous breast reconstruction, a sufficient flap volume is fundamental to restore breast shape and ensure an aesthetic outcome. After mastectomy, postoperative irradiation is regularly indicated in the oncological treatment algorithm. When administering radiation therapy after autologous reconstruction, the tissue transferred is inherently [...] Read more.
In autologous breast reconstruction, a sufficient flap volume is fundamental to restore breast shape and ensure an aesthetic outcome. After mastectomy, postoperative irradiation is regularly indicated in the oncological treatment algorithm. When administering radiation therapy after autologous reconstruction, the tissue transferred is inherently irradiated. Although there is evidence that points to a reduction in flap volume after adjuvant radiotherapy, the data have been contradicting and inconclusive. To address this anecdotal evidence, we performed a scoping review of the current literature that addresses the effect of radiotherapy on breast flap volume. Six two-armed studies, comprising a total of 462 patients, reported on the effect of adjuvant radiotherapy on free flap volume changes. Of those, two studies found a significant negative impact of radiotherapy on free flap volume, while the other four studies did not. Reported flap volume changes ranged from no change to a reduction of 26.2%, measured up to two years postoperatively. The selected studies contain varying patient numbers, follow-up timepoints, types of flaps, and measuring methods, contributing to a relatively high heterogeneity. While we present some evidence suggesting a significant impact of adjuvant radiotherapy on breast flap volume, future studies are needed to further investigate this potential correlation. Full article
(This article belongs to the Special Issue Breast Reconstruction: Clinical Updates and Perspectives)
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19 pages, 2059 KiB  
Review
Abdominal-Based Microsurgical Breast Reconstruction: How to Inset the Flap to Maximize the Aesthetic Result—A Systematic Review
by Gianluca Sapino, Sherilyn K. Tay, Michele Maruccia, Lloyd Nanhekhan, William Watfa, Gian Piero Mantovani, David Guillier, Pasquale Tedeschi, Russell Bramhall and Pietro Giovanni Di Summa
J. Clin. Med. 2023, 12(19), 6135; https://doi.org/10.3390/jcm12196135 - 22 Sep 2023
Cited by 1 | Viewed by 1141
Abstract
Nowadays, the ultimate goal of microsurgical breast reconstruction is not merely the effective transfer of vascularized tissue but the achievement of a natural, symmetric appearance. The aim of this present study was to systematically summarize the published evidence on abdominal-based free flap inset [...] Read more.
Nowadays, the ultimate goal of microsurgical breast reconstruction is not merely the effective transfer of vascularized tissue but the achievement of a natural, symmetric appearance. The aim of this present study was to systematically summarize the published evidence on abdominal-based free flap inset for breast reconstruction in order to provide principles and classification that could guide the surgeon in choosing the most appropriate inset technique based on patient and flap characteristics. A comprehensive review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, looking for articles on the insetting technique for free flap breast reconstruction. After screening 306 publications, 24 papers (published from 1994 to 2020) were included in the study. We identified four main breast anatomical features on which the papers reviewed focused when describing their insetting technique: breast width, breast ptosis, breast projection, and upper pole fullness. Patient body type, type of mastectomy, and reported complications are also discussed. Flap shaping and inset during breast reconstruction are fundamental steps in any reconstructive procedure. Despite the low evidence in the current literature, this systematic review provides a framework to guide the surgeon’s decision-making and optimize the aesthetic outcomes of abdominal-based free flap breast reconstruction. Full article
(This article belongs to the Special Issue Breast Reconstruction: Clinical Updates and Perspectives)
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