Prepectoral Breast Reconstruction: Current Trends and Techniques

Foreword\nPreface\nAcknowledgments\nContents\nAbout the Editors\nList of Videos\n1: Evolution of Pre-Pectoral Breast Reconstruction\n	1.1	 Introduction\n	1.2	 Breast Implants\n	1.3	 Acellular Dermal Matrix (ADM)\n	1.4	 Mesh (ADMs) with Implants\n	1.5	 Direct-to-Implant Pre-Pectoral Breast Reconstruction\n	1.6	 Fat Grafting\n	1.7	 Evolution of Pre-Pectoral Breast Reconstruction Timeline\n	1.8	 Radiation\n	1.9	 Benefits of Pre-Pectoral Breast Reconstruction\n	1.10	 Complications Specific to Pre-Pectoral Breast Reconstruction\n	1.11	 Conclusion\n	References\n2: Anatomy of the Breast\n	2.1	 Introduction\n	2.2	 The Superficial Fascia System of the Breast\n		2.2.1	 The Basic Body Segment\n		2.2.2	 The Corpus Lamina\n		2.2.3	 Anterior and Posterior Lamina\n		2.2.4	 Circum-mammary Ligament\n		2.2.5	 Circulation of the Breast\n		2.2.6	 Lymphatic System of the Breast\n		2.2.7	 Innervation of the Breast\n	2.3	 Summary\n	References\n3: Understanding Breast Cancer Oncology: The Need for Mastectomy and Axillary Staging\n	3.1	 Introduction\n	3.2	 Surgical Treatment of Breast Cancer: Historical Perspective\n	3.3	 Indications for Mastectomy\n	3.4	 Types of Mastectomies\n	3.5	 Post-mastectomy Radiation Therapy\n	3.6	 Management of the Axilla in Early-stage Breast Cancer\n	3.7	 Downstaging the Axilla\n	3.8	 Summary with Tips\n	References\n4: Oncological Safety and Technical Advances in Skin and Nipple-Sparing Mastectomy\n	4.1	 Introduction\n	4.2	 History of Conservative Mastectomy\n	4.3	 Surgical Technique\n	4.4	 Complications\n	4.5	 Oncological Safety: Review to Date\n	4.6	 Cosmesis and Psychological Benefit\n	4.7	 Conclusion\n	4.8	 Summary with Tips\n	References\n5: Prepectoral Breast Reconstruction: Selection Criteria and Patient Considerations\n	5.1	 Introduction\n	5.2	 Preoperative Selection Considerations\n		5.2.1	 Patient Criteria\n		5.2.2	 Tumor-Specific Considerations\n	5.3	 Intraoperative Considerations\n		5.3.1	 Intraoperative Assessment of Mastectomy Flaps\n		5.3.2	 Cosmetic Considerations\n	5.4	 Postoperative Considerations\n		5.4.1	 Infection\n	5.5	 Conclusion\n	References\n6: Skin and Nipple-Sparing Mastectomy with Axillary Staging in Prepectoral Breast Reconstruction\n	6.1	 Introduction\n	6.2	 Skin and Nipple-sparing Mastectomy with Pre-Pectoral Breast Reconstruction: Surgical Planning\n	6.3	 Pre-Operative Marking\n	6.4	 Intraoperative Set-up\n		6.4.1	 Skin-Sparing Mastectomy: Incision Placement\n		6.4.2	 Nipple-Sparing Mastectomy: Incision Placement\n		6.4.3	 Raising the Skin Flaps and Removing the Breast\n		6.4.4	 Infection Prevention in Skin and Nipple-Sparing Mastectomy and Pre-Pectoral Breast Reconstruction\n		6.4.5	 Axillary Staging in the Setting of Skin and Nipple-Sparing Mastectomy and PPBR\n		6.4.6	 Sentinel Lymph Node Biopsy\n			6.4.6.1	 Sentinel Lymph Node Identification Technique\n			6.4.6.2	 Incision\n			6.4.6.3	 Surgical Technique\n		6.4.7	 Axillary Lymph Node Dissection\n			6.4.7.1	 Incision\n			6.4.7.2	 Surgical Technique\n	6.5	 Summary with Tips\n	References\n7: Importance of Tissue Perfusion and Assessment Methods of the Mastectomy Skin Flap\n	7.1	 Background\n	7.2	 Anatomy\n	7.3	 Preoperative Planning\n		7.3.1	 Patient-Specific Factors\n		7.3.2	 Nipple-Sparing Mastectomy\n		7.3.3	 Incision Design\n	7.4	 Intraoperative Considerations\n		7.4.1	 Mastectomy Flap Dissection\n		7.4.2	 Mastectomy Flap Quality\n	7.5	 Managing Compromised Flaps\n		7.5.1	 Intraoperative Considerations\n		7.5.2	 Postoperative Considerations\n	7.6	 Conclusions\n	References\n8: Meshes and Implants in Prepectoral Breast Reconstruction: Selecting the Right One\n	8.1	 Introduction\n	8.2	 Implant Selection\n		8.2.1	 Silicone vs Saline\n		8.2.2	 Textured vs Smooth\n		8.2.3	 Round vs Anatomic\n		8.2.4	 Cohesivity\n		8.2.5	 Base Width\n		8.2.6	 Implant Volume\n	8.3	 Implant Manufacturers\n		8.3.1	 Allergan\n		8.3.2	 Sientra\n		8.3.3	 Mentor\n		8.3.4	 Silimed\n		8.3.5	 Polytech\n		8.3.6	 Ideal Implant\n		8.3.7	 CG Aesthetics\n		8.3.8	 Laboratories Arion\n		8.3.9	 Hans Biomed\n		8.3.10	 Ceraplas\n		8.3.11	 Establishment Labs\n		8.3.12	 Sebbin\n		8.3.13	 Guangzhou Wanhe\n		8.3.14	 CollPlant\n	8.4	 Tissue Expanders\n	8.5	 Mesh Selection\n	8.6	 Biologic Meshes\n		8.6.1	 Alloderm\n		8.6.2	 Cortiva\n		8.6.3	 Dermamatrix\n		8.6.4	 FlexHD\n		8.6.5	 Dermacell\n		8.6.6	 SurgiMend\n		8.6.7	 Strattice\n		8.6.8	 Braxon\n	8.7	 Synthetic Meshes\n		8.7.1	 Absorbable Mesh\n		8.7.2	 Galatea Scaffold\n		8.7.3	 TIGR Matrix\n		8.7.4	 SERI Surgical Scaffold\n		8.7.5	 Permanent Mesh\n		8.7.6	 TriLoop Bra\n		8.7.7	 ULTRAPRO\n		8.7.8	 SERAGYN\n	8.8	 Surgical Tips\n	References\n9: Prepectoral Implant-Based Breast Reconstruction: Complete Cover with Preshaped Mesh\n	9.1	 Selection of Patients\n	9.2	 Indications\n	9.3	 Planning\n	9.4	 Technique\n	9.5	 Review of Literature\n	9.6	 Summary and Tips\n		9.6.1	 Preshaped Mesh\n	References\n10: Prepectoral Implant-Based Breast Reconstruction with Anterior Implant Coverage\n	10.1	 Introduction\n	10.2	 Single-Stage Direct-to-Implant (DTI) or Two-Stage Reconstruction\n	10.3	 Advantages and Disadvantages of Prepectoral Implant Placement\n		10.3.1	 Disadvantages of Prepectoral Implant Placement\n	10.4	 How to Cover the Implant\n	10.5	 Technique of the Anterior Coverage of the Implant\n	10.6	 Advancements in Technique and Materials\n	10.7	 The Seroma Discussion\n	10.8	 Prepectoral DTI Breast Reconstruction\n	10.9	 Results\n	10.10	 Prepectoral DTI in Large and Ptotic Breasts\n	10.11	 Conclusion\n	References\n11: Prepectoral Anterior Coverage Breast Reconstruction\n	11.1	 Introduction\n	11.2	 Anterior Coverage Versus Full Device Wrap?\n	11.3	 Materials and Methods\n	11.4	 Operative Procedure\n	11.5	 Anterior Suturing Technique\n	11.6	 Results\n	11.7	 Discussion\n	11.8	 Conclusion\n	References\n		Further Reading\n12: Breast Reconstruction Using a Prepectoral Spacer\n	12.1	 Procedure\n	12.2	 Discussion\n	12.3	 Poorly Vascularized Portions of the Flap Are Not Excised at the Time of the Mastectomy\n	12.4	 Conclusion\n	References\n13: Synthetic Meshes in Prepectoral Breast Reconstruction\n	13.1	 Introduction\n	13.2	 Patients’ Selection\n	13.3	 Synthetic Meshes\n	13.4	 Surgical Technique\n	13.5	 Autologous Adipose Tissue Grafting\n	13.6	 Complications\n	13.7	 Review of Short Literature to Date\n	13.8	 Summary with Tips\n	References\n14: Hybrid Prepectoral Breast Reconstruction: Combining Flaps and Implants\n	14.1	 Introduction\n	14.2	 Timing of Implant Placement\n	14.3	 Radiation Therapy\n	14.4	 Plane of Implant Placement\n	14.5	 Surgical Technique\n	14.6	 Advantages of Hybrid Breast Reconstruction\n	14.7	 Literature Review\n	14.8	 Summary\n	References\n15: Prepectoral Breast Reconstruction Without Mesh\n	15.1	 Introduction\n	15.2	 Indications and Contraindications\n	15.3	 Surgical Technique\n	15.4	 Clinical Outcomes\n	15.5	 Considerations\n	15.6	 Conclusions\n	References\n16: Prepectoral Skin-Reducing Pattern\n	16.1	 Introduction\n	16.2	 Indications\n	16.3	 Technique\n		16.3.1	 Preoperative Drawing\n		16.3.2	 Demolition Phase\n		16.3.3	 Reconstruction Phase\n	16.4	 Postoperative Care\n	16.5	 Results and Complications\n	16.6	 Review of Short Literature to Date\n	References\n17: Complications: How to Reduce and Manage\n	17.1	 Introduction\n	17.2	 Type of Complications\n	17.3	 Risk Factors for COMPLICACTION\n	17.4	 Early Complications\n		17.4.1	 Seroma\n			17.4.1.1	 Prevention\n				Suction Drainage\n				Quilting Suture\n				Tissue Sealants\n				Surgical Cutting Devices\n				Axillary Dissection Technique\n				Avoidance of Active Shoulder Mobilization\n				External Soft Compression\n			17.4.1.2	 Management\n		17.4.2	 Hematoma\n			17.4.2.1	 Prevention\n			17.4.2.2	 Management\n		17.4.3	 Skin/Nipple–Areola Complex Necrosis\n			17.4.3.1	 Prevention\n			17.4.3.2	 Management\n		17.4.4	 Infection\n			17.4.4.1	 Prevention\n			17.4.4.2	 Management\n		17.4.5	 Wound Dehiscence\n			17.4.5.1	 Prevention\n			17.4.5.2	 Management\n		17.4.6	 Red Breast Syndrome\n			17.4.6.1	 Prevention and Management\n		17.4.7	 Implant Extrusion\n	17.5	 Late Complications\n		17.5.1	 Capsular Contracture\n			17.5.1.1	 Prevention\n			17.5.1.2	 Management\n		17.5.2	 Implant Displacement\n			17.5.2.1	 Prevention\n			17.5.2.2	 Management\n		17.5.3	 Rippling\n			17.5.3.1	 Prevention\n			17.5.3.2	 Management\n		17.5.4	 Visible Implant Edge\n	17.6	 Conclusion\n	References\n18: Clinical, Histological, and Ultrasound Follow-Up of Breast Reconstruction with One-Stage Prepectoral Breast Reconstruction\n	18.1	 Introduction\n	18.2	 Main Manuscript\n	18.3	 Clinical Follow-Up\n	18.4	 Histological Follow-Up\n	18.5	 Ultrasound Follow-Up\n	18.6	 Review of Short Literature to Date\n	18.7	 New Generation ADMs: Three-Dimensional Matrices\n	18.8	 New Generation ADMs: Matrices with Adipogenic Stimulus\n	18.9	 Summary with Tips\n	References\n19: Prepectoral Implants and Radiation Therapy\n	19.1	 Introduction\n	19.2	 Role of Postmastectomy Radiation\n	19.3	 Radiation Target and Technique\n	19.4	 Radiation Fractionation\n	19.5	 Types of Breast Reconstruction and Radiation\n	19.6	 Types of Expander and Radiation Therapy\n	19.7	 Types of Mastectomies and Radiation Therapy Timing\n	19.8	 Conclusion\n	References\n20: Planning Pre-pectoral Implant-Based Breast Reconstruction When Confronted with XRT\n	20.1	 Introduction\n	20.2	 Radiotherapy (XRT)\n		20.2.1	 The Need\n		20.2.2	 Improvements of Radiation Throughout the Years\n		20.2.3	 Classification of Tissue Damage\n		20.2.4	 XRT Before Reconstruction\n	20.3	 Pre-pectoral Reconstruction in Face of XRT Before the Reconstruction\n		20.3.1	 Why?\n		20.3.2	 Advantages as Compared with Sub-pectoral\n		20.3.3	 XRT After Reconstruction\n		20.3.4	 Influence on the Tissues\n		20.3.5	 Pre-pectoral Reconstruction in the Face of Expected XRT After Reconstruction\n		20.3.6	 Two-Stage vs. One-Stage Reconstruction\n	20.4	 Summary\n	20.5	 Review of Short Literature to Date Summary with Tips\n		20.5.1	 Tips\n	References\n21: Fat Grafting for Volume Augmentation in Prepectoral Breast Reconstruction\n	21.1	 Introduction\n	21.2	 Operative Technique\n	21.3	 Discussion\n	21.4	 Summary\n	References\n22: The LOTUS Pre-pectoral Breast Reconstruction\n	22.1	 Introduction\n		22.1.1	 Minimally Invasive Mastectomy\n		22.1.2	 LOTUS Breast Reconstruction\n	22.2	 Results\n		22.2.1	 Recommended Post Reconstruction Surveillance\n		22.2.2	 Reconstruction Outcome Grading\n		22.2.3	 Conclusions\n	References\n23: Endoscopic-Assisted Nipple and Skin Sparing Mastectomy\n	23.1	 Introduction\n	23.2	 Detailed Technique Description [16]\n		23.2.1	 Positioning and Sentinel Lymph Node Biopsy\n		23.2.2	 Skin Incision for E-NSM\n		23.2.3	 Posterior Plane Dissection\n		23.2.4	 Skin Flap Dissection\n		23.2.5	 Single Port Air Inflation or Retraction Type E-NSM\n		23.2.6	 Sub-nipple Biopsy\n		23.2.7	 Subpectoral Prothesis Breast Reconstruction\n	23.3	 Current Evidence on Endoscopic-Assisted Nipple and Skin Sparing Mastectomy in Terms of Indications, Techniques, and Outcome Measures (Table 23.1) [17]\n		23.3.1	 Indication for E-NSM [7, 15, 16]\n		23.3.2	 Technique Refinements of E-NSM\n		23.3.3	 Aesthetic Outcome\n	23.4	 Discussion\n		23.4.1	 Dual Incision\n		23.4.2	 Single Axillary Incision Hybrid E-NSM [15]\n		23.4.3	 Insufflation Technique [6, 15, 16]\n		23.4.4	 3-Dimensional (3D) Imaging [16]\n		23.4.5	 Other Advancements in Endoscopic-Assisted Breast Surgery: Robotic-Assisted Nipple Sparing Mastectomy\n		23.4.6	 Implant Reconstruction with Endoscopic-Assisted Mastectomy: Subpectoral vs Pre-pectoral Implant Placement\n	23.5	 Conclusion\n	References\n24: The Functional and Cost-Effectiveness of Prepectoral Breast Reconstruction\n	24.1	 Functional Evaluation of Prepectoral ADM-Assisted Breast Reconstruction\n		24.1.1	 Introduction\n		24.1.2	 Background of Breast Reconstruction\n		24.1.3	 Notes of Chest Wall Area Functional Anatomy\n		24.1.4	 Subjective Validated Tests to Evaluate Upper Limb Function\n		24.1.5	 Objective Validated Tests to Evaluate Upper Limb Function\n		24.1.6	 Functional Impact of Breast and Reconstructive Surgery\n		24.1.7	 Pro-active Physiotherapist Approach\n		24.1.8	 Functional Advantages of Prepectoral Breast Reconstruction\n	24.2	 Economic Evaluation of Prepectoral ADM-Assisted Breast Reconstruction\n		24.2.1	 Introduction\n		24.2.2	 Causes of a Suboptimal Rate of Breast Reconstruction\n			24.2.2.1	 Availability of Various Approaches to Breast Reconstruction\n			24.2.2.2	 Acceptability of Breast Reconstruction\n		24.2.3	 Bases of the Economical Evaluation\n			24.2.3.1	 Operative Time\n			24.2.3.2	 Duration of Hospitalization\n			24.2.3.3	 Pain and the Need for Analgesics\n			24.2.3.4	 Physical and Functional Integrity\n			24.2.3.5	 Normal Activity Recovery Time\n			24.2.3.6	 Stability of the Reconstructed Breast and Need for Revision Surgery\n			24.2.3.7	 Aesthetic Outcome and Patient Satisfaction\n		24.2.4	 In-Hospital Costs\n		24.2.5	 Monetary Evaluation of Outcomes\n	24.3	 Conclusion\n	24.4	 Summary with Tips\n	References\n25: Prepectoral Breast Reconstruction Using a Bio-Synthetic Scaffold\n	25.1	 Introduction\n	25.2	 Procedure\n		25.2.1	 Results\n	25.3	 Discussion\n	25.4	 Conclusion\n	References\nIndex