Post-mastectomy Breast Reconstruction with Autologous Tissue: Current Methods and Techniques

Abstract

Summary Breast reconstruction is an option that should be considered for any patient facing a mastectomy. Autologous breast reconstruction provides the benefits of excellent longterm results, natural appearance, natural feel, and the best opportunity for sensory restoration. These factors lead many patients to choose autologous tissue over implant-based reconstruction. With improved anatomic and technical knowledge, the donor site morbidity previously associated with abdominally based autologous reconstruction has been significantly reduced. Today, the DIEP flap is the preferred autologous method allowing restoration of a “natural,” aesthetic breast with potential for sensation while simultaneously minimizing abdominal donor site morbidity. Alternative flaps and adjunctive procedures provide options when dealing with patients who present with challenging clinical scenarios because of an inadequate abdominal donor site. This paper reviews current methods employed by a high volume breast reconstruction practice to achieve these goals.

Breast Reconstruction: Necessity for Further Standardization of the Current Surgical Techniques Attempting to Facilitate Scientific Evaluation and Select Tailored Individualized Procedures Optimizing Patient Satisfaction

“…Notably, two types of autologous breast reconstruction techniques can be described. Firstly, the vascularized pedicled skin/muscle flaps with examples including the latissimus dorsi flap, the TRAM flap, and secondly the free flaps with examples including the DIEP flap, the superficial inferior epigastric artery flap, the gluteal artery perforator flaps, and the profunda artery perforator (PAP) flap [2, 11].…”

“…Alternative flap options include thigh-based flaps also used as stacked flaps, such as the posterior thigh-based PAP flap, the inner thigh-based transverse upper gracilis (TUG) flap, or the newly described TUGPAP, all presented as reliable with low morbidity and satisfactory cosmesis additionally to the first described tensor fasciae latae myocutaneous free flap [2, 18, 19]. In a recent systematic review of breast reconstruction with PAP, TUG, or TUGPAP flaps, TUG flaps had a significantly higher recipient and donor complication rate compared with both PAP and TUGPAP flaps, concluding that the TUGPAP flap is a safe and effective alternative.…”

“…Single-stage direct-to-implant reconstruction and autologous tissue reconstruction can be performed in a single operation. In contrast, a two-stage tissue expander/implant reconstruction demands at least two operations [1, 2].…”

“…Innovation and improved imaging techniques have enabled to map out perforators and harvest flaps from every part of the human body. However, objective comparisons of esthetic outcomes are challenging and require long-term follow-up [2-5].…”

“…Unfortunately, studies presented in the literature so far present a significant selection bias due to nonstandard methods of assessing complications and presentation of inadequate data on radiotherapy timing and technique. Robust evidence and standardization of the various novel surgical techniques is lacking, while benefits of other adjunctive surgical techniques, such as fat grafting attempting to correct contour deformities after radiotherapy are debatable and still unknown [2-6].…”