ADVANCES IN BREAST CANCER DIAGNOSIS AND TREATMENT: ESSENTIALS

Advances in breast cancer diagnosis and treatment Essentials_kapak

IMPLANT-BASED BREAST RECONSTRUCTION

Buse Çapkınoğlu

Private Physician, Department of Plastic, Reconstructive and Aesthetic Surgery, İstanbul, Türkiye

Çapkınoğlu B. Implant-Based Breast Reconstruction. In: Citgez B editor. Advances in Breast Cancer Diagnosis and Treatment Essentials. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.191-208.

ABSTRACT

This review aims to provide a comprehensive overview of implant-based breast reconstruction following mastectomy, focusing on its historical development, surgical techniques, patient selection criteria, complication management, and patient satisfaction outcomes.Through a critical evaluation of recent literature, the review examines the evolution of implant-based reconstruction, comparing subpectoral and prepectoral placements, one-stage and two-stage approaches, and various implant types and surface textures. Additionally, patient-reported outcomes and emerging technologies are discussed.

Implant-based breast reconstruction is widely adopted due to its relative simplicity, reduced operative time, and absence of donor site morbidity. Subpectoral placement has been the traditional approach, but prepectoral placement is gaining favor due to reduced pain and elimination of animation deformity in selected patients. One-stage reconstruction offers immediate aesthetic outcomes but requires strict patient selection.

Key complications such as capsular contracture, infection, and implant loss are discussed along with effective management strategies. Patient satisfaction depends not only on aesthetic success but also on overall quality of life, psychological recovery, and functional outcomes. Advances in surgical techniques, particularly the use of acellular dermal matrices (ADMs) and fat grafting, have improved outcomes in recent years. These adjuncts have expanded the indications for immediate reconstruction, even in patients previously considered high risk. Moreover, the increasing use of validated patient-reported outcome measures, such as BREAST-Q, highlights the importance of incorporating patient perspectives into surgical decision-making and outcome assessment.

Additional factors influencing outcomes include the timing of reconstruction, the role of adjuvant therapies, and the management of high-risk patients with comorbidities such as diabetes, obesity, or previous radiotherapy. Recent multicenter studies emphasize that reconstructive choices must be individualized, taking into account not only oncological safety but also patient expectations, cultural context, and access to healthcare resources. Long-term follow-up data also support the oncological safety of implant-based reconstruction, with no adverse impact on recurrence or survival outcomes.

As clinical practice evolves, a multidisciplinary approach involving oncologists, breast surgeons, and reconstructive specialists will be central to achieving optimal results. The combination of technical progress, patient-centered care, and innovative technologies continues to strengthen its role as an indispensable component of modern oncological management. Looking forward, integration of 3D printing, bioengineered implants, and augmented reality-assisted surgery promises to further expand the scope and precision of implant-based reconstruction. Collectively, these advances underline the importance of implant-based breast reconstruction as a cornerstone of comprehensive breast cancer care, empowering patients with restored physical integrity and renewed self-confidence.

Keywords: Breast neoplasms; Breast implants; Mammaplasty; Mastectomy, segmental

Referanslar

  1. Türk KE, Yılmaz M. The effect on quality of life and body image of mastectomy among breast cancer survivors. Eur J Breast Health. 2018;14(4):205-210. [Crossref]  [PubMed]  [PMC]
  2. Amro C, Sorenson TJ, Boyd CJ, et al. The evolution of implant-based breast reconstruction: innovations, trends, and future directions. J Clin Med. 2024;13(23):7407. [Crossref]  [PubMed]  [PMC]
  3. Lalardrie JP, Mouly R. History of mammaplasty. Aesthetic Plast Surg. 1978;2:167-176. [Crossref]  [PubMed]
  4. Czerny V. Plastic replacement of the breast with a lipoma. Chir Kong Verhandl. 1895;2:216.
  5. Cronin TD, Brauer RO. Augmentation mammaplasty. Surg Clin North Am. 1971;51(2):441-452. [Crossref]  [PubMed]
  6. Rudolph R, Abraham J, Vecchione T, Guber S, Woodward M. Myofibroblasts and free silicon around breast implants. Plast Reconstr Surg. 1978;62(2):185-196. [Crossref]  [PubMed]
  7. Argenta LC. Migration of silicone gel into breast parenchyma following mammary prosthesis rupture. Aesthetic Plast Surg. 1983;7(4):253-254. [Crossref]  [PubMed]
  8. Thomsen JL, Christensen L, Nielsen M, et al. Histologic changes and silicone concentrations in human breast tissue surrounding silicone breast prostheses. Plast Reconstr Surg. 1990;85(1):38-41. [Crossref]  [PubMed]
  9. Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg. 1982;69:195-208. [Crossref]  [PubMed]
  10. Institute of Medicine (US); Grigg M, Bondurant S, Ernster VL, et al., eds. Information for Women About the Safety of Silicone Breast Implants. Washington, DC: National Academies Press (US); 2000.
  11. Brody GS, Deapen D, Taylor CR, et al. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg. 2015;135:695-705. [Crossref]  [PubMed]
  12. Tanne JH. FDA approves silicone breast implants 14 years after their withdrawal. BMJ. 2006;333(7579):1139. [Crossref]  [PubMed]  [PMC]
  13. Sbitany H, Langstein HN. Acellular dermal matrix in primary breast reconstruction. Aesthetic Surg J. 2011;31(7 Suppl):30S-37S. [Crossref]  [PubMed]
  14. Wang J, Shammas RL, Montes-Smith E, et al. Complications and patient-reported outcomes in prepectoral vs submuscular breast reconstruction following nipple sparing mastectomy. Plast Reconstr Surg. Published online March 17, 2025. [Crossref]
  15. Losken A, Pinell XA, Sikoro K, Yezhelyev MV, Anderson E, Carlson GW. Autologous fat grafting in secondary breast reconstruction. Ann Plast Surg. 2011;66(5):518-522. [Crossref]  [PubMed]
  16. Nahabedian MY. Implant-based breast reconstruction: strategies to achieve optimal outcomes and minimize complications. J Surg Oncol. 2016;113(8):895-905. [Crossref]  [PubMed]
  17. Eck DL, McLaughlin SA, Terkonda SP, Rawal B, Perdikis G. Effects of immediate reconstruction on adjuvant chemotherapy in breast cancer patients. Ann Plast Surg. 2015;74(suppl 4):S201-S203. [Crossref]  [PubMed]
  18. Lin KY, Blechman AB, Brenin DR. Implant-based, twostage breast reconstruction in the setting of radiation injury: an outcome study. Plast Reconstr Surg. 2012;129(4):817823. [Crossref]  [PubMed]
  19. Langstein HN, Cheng MH, Singletary SE, et al. Breast cancer recurrence after immediate reconstruction: patterns and significance. Plast Reconstr Surg. 2003;111(2):712-720. [Crossref]  [PubMed]
  20. Blok YL, van Lierop E, Plat VD, et al. Implant loss and associated risk factors following implant-based breast reconstructions. Plast Reconstr Surg Glob Open. 2021;9(7):e3708. [Crossref]  [PubMed]  [PMC]
  21. Vidya R, Berna G, Sbitany H, et al. Prepectoral implant-based breast reconstruction: a joint consensus guide from UK, European and USA breast and plastic reconstructive surgeons. Ecancermedicalscience. 2019;13:927. [Crossref]  [PubMed]  [PMC]
  22. Piccolo PP, Venturi M, Mesbahi AN, Nahabedian MY. Current status prepectoral and subpectoral breast reconstruction in the USA. Gland Surg. 2023;12(12):1794-1805. [Crossref]  [PubMed]  [PMC]
  23. Ching AH, Lim K, Sze PW, Ooi A. Quality of life, pain of prepectoral and subpectoral implant-based breast reconstruction with a discussion on cost: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2022;75(8). [Crossref]  [PubMed]
  24. Araco A, Caruso R, Araco F, Overton J, Gravante G. Capsular contractures: a systematic review. Plast Reconstr Surg. 2009;124(6):1808-1819. [Crossref]  [PubMed]
  25. Alnaif N, Safran T, Viezel-Mathieu A, Alhalabi B, Dionisopoulos T. Treatment of breast animation deformity: a systematic review. J Plast Reconstr Aesthet Surg. 2019;72(5):781788. [Crossref]  [PubMed]
  26. Vidya R, Iqbal FM, Becker H, Zhadan O. Rippling associated with pre-pectoral implant based breast reconstruction: a new grading system. World J Plast Surg. 2019;8(3):311.
  27. Kim DS, Moon YJ, Lee HC, et al. Risk factor analysis and clinical experience of treating capsular contracture after prepectoral implant-based breast reconstruction. Gland Surg. 2024;13(6):987. [Crossref]  [PubMed]  [PMC]
  28. Bellini E, Pesce M, Santi P, Raposio E. Two-stage tissue-expander breast reconstruction: a focus on the surgical tech nique. Biomed Res Int. 2017;2017:1791546. [Crossref]  [PubMed]  [PMC]
  29. Colwell AS. Direct-to-implant breast reconstruction. Gland Surg. 2012;1(3):139.
  30. Headon H, Kasem A, Mokbel K. Capsular contracture after breast augmentation: an update for clinical practice. Arch Plast Surg. 2015;42(5):532-543. [Crossref]  [PubMed]  [PMC]
  31. Rezende-Pereira G, Albuquerque JP, Souza MC, et al. Biofilm formation on breast implant surfaces by major gram-positive bacterial pathogens. Aesthetic Surg J. 2021;41(10):1144-1151. [Crossref]  [PubMed]
  32. Patel R, Somogyi RB. Comparing post-surgical outcomes of pre-pectoral versus dual-plane direct-to-implant breast reconstruction without increasing the use of acellular dermal matrix. J Plast Reconstr Aesthet Surg. 2022;75(3):11231129. [Crossref]  [PubMed]
  33. Vinsensia M, et al. Incidence and risk assessment of capsular contracture in breast cancer patients following post-mastectomy radiotherapy and implant-based reconstruction. Cancers. 2024;16(2):265. [Crossref]  [PubMed]  [PMC]
  34. Saibene T, Cecconi C, Toffanin MC, et al. Incidence of capsular contracture on irradiated acellular dermal matrices (ADMs)-assisted prepectoral breast reconstructions. Ann Breast Surg. 2023;7. [Crossref]
  35. Tan QW, et al. Autologous fat grafting for breast reconstruction. Cochrane Database Syst Rev. 2021;6:CD010793. [Crossref]  [PMC]
  36. Azouz V, Mirhaidari S, Wagner DS. Defining infection in breast reconstruction: a literature review. Ann Plast Surg. 2018;80(5):587-591. [Crossref]  [PubMed]
  37. Ho G, Nguyen TJ, Shahabi A, Hwang BH, Chan LS, Wong AK. A systematic review and meta-analysis of complications associated with acellular dermal matrix-assisted breast reconstruction. Ann Plast Surg. 2012;68(4):346-356. [Crossref]  [PubMed]
  38. Longo B, Di Napoli A, Curigliano G, et al. Clinical recommendations for diagnosis and treatment according to current updated knowledge on BIA-ALCL. Breast. 2022;66:332-341. [Crossref]  [PubMed]  [PMC]
  39. Schmauss D, Machens HG, Harder Y. Breast reconstruction after mastectomy. Front Surg. 2015;2:71. [Crossref]  [PubMed]  [PMC]
  40. Roth RS, Qi J, Hamill JB, et al. Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction. Breast. 2018;37:119-125. [Crossref]  [PubMed]  [PMC]
  41. Colakoglu S, et al. Impact of complications on patient satisfaction in breast reconstruction. Plast Reconstr Surg. 2011;127(4):1428-1436. [Crossref]  [PubMed]
  42. Jang Y, Seong M, Sok S. Influence of body image on quality of life in breast cancer patients undergoing breast reconstruction: mediating of self-esteem. J Clin Nurs. 2023;32(17-18):6366-6373. [Crossref]  [PubMed]
  43. Wei CH, et al. Psychosocial and sexual well-being following nipple-sparing mastectomy and reconstruction. Breast J. 2016;22(1):10-17. [Crossref]  [PubMed]  [PMC]
  44. Eltahir Y, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2013;132(2):201e-209e. [Crossref]  [PubMed]
  45. Cohen WA, et al. Understanding and optimizing the patient experience in breast reconstruction. Ann Plast Surg. 2016;77(2):237-241. [Crossref]  [PubMed]  [PMC]
  46. Barry M, Kell MR. Radiotherapy and breast reconstruction: a meta-analysis. Breast Cancer Res Treat. 2011;127:15-22. [Crossref]  [PubMed]
  47. Donnely E, Griffin M, Butler PE. Breast reconstruction with a tissue engineering and regenerative medicine approach (systematic review). Ann Biomed Eng. 2020;48(1):9-25. [Crossref]  [PubMed]  [PMC]