Algorithm postmastectomy breast reconstruction secondary to breast cancer in a reference center in Mexico City

Esperanza Sánchez-Castrejón; Daniel Garza-Arriaga; Aaron González-Espinosa

doi:10.18203/2349-2902.isj20242755

Authors

Esperanza Sánchez-Castrejón Department of Plastic and Reconstructive Surgery, Dr. Manuel Gea González General Hospital, Mexico City, Mexico
Daniel Garza-Arriaga Department of Plastic and Reconstructive Surgery, Breast Diseases Institute, Mexico City, Mexico
Aaron González-Espinosa Department of Plastic and Reconstructive Surgery, Breast Diseases Institute, Mexico City, Mexico

DOI:

https://doi.org/10.18203/2349-2902.isj20242755

Keywords:

Breast cancer, Breast reconstruction, Alloplastics, Flaps

Abstract

Background: Postmastectomy breast reconstruction represents a challenge for the plastic surgeon. Contemporary techniques offer numerous options, the reconstructive procedure performed depends on the individual profile of each patient, but will also be influenced by the surgeon's preoperative analysis of their individualized risk profile.

Methods: Descriptive, longitudinal, and retrospective study. The reconstructed patients with breast cancer sequelae in the period from May 2023 to May 2024 were included. Based on the review of the literature and the experience of our center, a proposal for a breast reconstruction algorithm was formulated to standardize the ideal surgical treatment according to the case.

Results: 119 patients were reconstructed using the algorithm to decide the ideal surgical management. Breast reconstruction was performed in 3 stages: the first stage [1st BRS] (119 patients) consisted of a tissue expander, breast implant ± acellular dermal matrix or autologous pedicled flaps after the mastectomy; in the 2nd BRS (68 patients) the expander was replaced with an implant with or without contralateral symmetrization; and finally in the 3rd BRS (18 patients), the reconstruction of the nipple-areola complex ± neurotization, autologous fat transfer and scar remodeling was performed.

Conclusions: The algorithm proposed in this paper provides a guide for making decisions about ideal surgical management according to the clinical characteristics of each subgroup of patients to be reconstructed, improving results by making them reliable and predictable, which positively impacts patient's quality of life.

Metrics

Metrics Loading ...

References

World Health Organization. International Agency for Research on Cancer. Global Cancer Observatory. Available at: https://gco.iarc.fr/. Accessed on 01 January 2024.

Health Secretary. Protocol of the National Nutrition Survey. Mexico, DF: General Directorate of Epidemiology. National Health Survey System. 2022. Available at: https://en.www.inegi.org. mx/programas/ensanut/2018/. Accessed on 01 January 2024.

Colwell AS, Taylor EM. Recent Advances in Implant-Based Breast Reconstruction. Plast Reconstr Surg. 2020;145(2):421-32.

Tomita K, Kubo T. Recent advances in surgical techniques for breast reconstruction. Int J Clin Oncol. 2023;28(7):841-6.

Panchal H, Matros E. Current Trends in Postmastectomy Breast Reconstruction. Plast Reconstr Surg. 2017;140(5S):7-13.

Rocco N, Catanuto G, Nava MB. Radiotherapy and breast reconstruction. Minerva Chir. 2018;73(3):322-8.

O'Halloran N, Potter S, Kerin M, Lowery A. Recent Advances and Future Directions in Postmastectomy Breast Reconstruction. Breast Cancer Clin. 2018;18(4):e571-85.

Alessandri Bonetti M, Carbonaro R, Borelli F, Amendola F, Cottone G, et al. Outcomes in Hybrid Breast Reconstruction: A Systematic Review. Medicine (Kaunas). 2022;58(9):1232.

Demiri EC, Dionyssiou DD, Tsimponis A, Goula CO, Pavlidis LC, Spyropoulou GA. Outcomes of Fat-Augmented Latissimus Dorsi (FALD) Flap Versus Implant-Based Latissimus Dorsi Flap for Delayed Post-radiation Breast Reconstruction. Aesthetic Plast Surg. 2018;42(3):692-701.

McCarthy CM, Mehrara BJ, Riedel E, Davidge K, Hinson A, Disa JJ, et al. Predicting Complications Following Expander/Implant Breast Reconstruction: An Outcomes Analysis Based on Preoperative Clinical Risk. Plast Reconstruct Surg. 2008;121(6):1886-92.

Huo J, Smith BD, Giordano SH, Reece GP, Shih Y. Post-mastectomy breast reconstruction and its subsequent complications: a comparison between obese and non-obese women with breast cancer. Breast Cancer Res Treatment. 2016;157(2):373-83.

Cevallos P, Berry C, Lipman KJ, Kubiak CA, Mohan AT, Ayyala HS, et al. Breast reconstruction after mastectomy in patients with obesity: a narrative review. Ann Transl Med. 2023;11(12):413.

Nelson JA, Disa JJ. Breast Reconstruction and Radiation Therapy: An Update. Plast Reconstr Surg. 2017;140(5S):60-8.

Yueh JH, Slavin SA, Adesiyun T, Nyame TT, Gautam S, Morris DJ, et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg. 2010;125(6):1585-95.

Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction. JAMA Surg. 2018;153(10):891-9.

Djohan R, Scomacao I, Knackstedt R, Cakmakoglu C, Grobmyer SR. Neurotization of the Nipple-Areola Complex during Implant-Based Reconstruction: Evaluation of Early Sensation Recovery. Plast Reconstr Surg. 2020;146(2):250-4.