Subcutaneous implant-based breast reconstruction, a modern challenge in post mastectomy radiation planning

Publication date: Available online 8 September 2017
Source:Practical Radiation Oncology
Author(s): Melissa P. Mitchell, Jamie Wagner, James Butterworth
As survival rates for breast cancer continue to improve, there has been increasing interest in reducing toxicity of therapy. In the field of breast surgery, we have seen advancements in the surgical approach from total mastectomy to skin and nipple sparing mastectomy. Nodal surgery has also been significantly impacted by a "less is more" approach, sparing patients with healthy lymph nodes the side effect of axillary lymph node dissection by performing sentinel lymph node dissection to accurately assess the draining nodal basin. More recently, there have been increasing reports of techniques to improve options for reconstruction. A growing trend has been use of acellular dermal matrix (ADM). This has been reported to improve cosmesis and reduce the number of surgical procedures required to obtain desired aesthetic results. Additionally, there have been increasing reports of use of prepectoral ADM covered implants. As compared to traditional methods of using submuscular tissue expanders, devices placed in the prepectoral plane have been reported to reduce animation deformities and postoperative pain. There is also the benefit that muscular function will be preserved with a subcutaneous expander. Furthermore, there is a growing push for single stage procedures made possible through the use of ADM. This benefits the patient by subjecting them to less operations and benefits the health care system by decreasing health care costs, as compared to multiple stage surgeries.



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