Prepectoral Breast Reconstruction: Current Trends and Techniques

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