Unilateral Tissue Expander/Implant Two-Stage Breast Reconstruction with the Assistance of Three-Dimensional Surface Imaging

The Impact of Subpectoral Tissue Expander Applications on Thoracic Deformity: Retrospective Analytic Study on Mastectomy Patients

INTRODUCTION

With the rising incidence of breast cancer, post-mastectomy breast reconstructions have become increasingly common. Early implant-based reconstructions placed implants subcutaneously, leading to complications, like flap necrosis and implant malposition. Subsequently, the sub-muscular approach gained popularity for its improved outcomes. Tissue expanders have become integral to breast reconstruction, offering a two-stage process with reduced morbidity. However, their use poses challenges, such as chest wall deformities, influenced by a range of variables (age, radiotherapy, and expander volume). This study aimed to explore these correlations.

MATERIALS AND METHODS

This retrospective study obtained ethical approval and consent was given by 47 patients undergoing immediate two-stage expander-to-implant breast reconstruction between 2013 and 2023. Sterno-costal angles, total expander volume, perioperative filling, and radiotherapy (RT) were evaluated. Pre- and postoperative imaging, including CT and PET-CT scans, assessed chest wall deformities. Patients with osteoporosis, smokers, or pre-existing chest wall deformities were excluded. Standard reconstruction involved creating a sub-muscular pocket, with expanders fixed to the sixth costal periosteum.

RESULTS

Sixty-nine breast of the 47 patients (median age 44 years) were included. Postoperative RT was administered to 46 breasts. Median total expander volume was 360 mL, with an initial fill volume of 45 mL. Postoperative mastectomy wound complications affected eight breasts and were resolved with dressings. Chest wall deformity, indicated by significant postoperative sterno-costal angle changes (p < 0.001), was observed in 82.6% of breasts. No significant differences were found between right- and left-sided deformities (p = 0.47), nor were correlations noted with RT (p = 0.57), total expander volume (p = 0.271), or initial filling volume (p = 0.759).

CONCLUSION

This study confirms the association between tissue expanders and chest wall deformities in breast reconstruction. Despite the absence of significant correlations with age, RT, or expander volume, the high incidence of deformities highlights the need for further investigation. Understanding these relationships is crucial for optimizing outcomes in breast reconstruction procedures involving tissue expanders.

LEVEL OF EVIDENCE III

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Three-Dimensional Printing in Breast Reconstruction: Current and Promising Applications

Three-dimensional (3D) printing is dramatically improving breast reconstruction by offering customized and precise interventions at various stages of the surgical process. In preoperative planning, 3D imaging techniques, such as computer-aided design, allow the creation of detailed breast models for surgical simulation, optimizing surgical outcomes and reducing complications. During surgery, 3D printing makes it possible to customize implants and precisely shape autologous tissue flaps with customized molds and scaffolds. This not only improves the aesthetic appearance, but also conforms to the patient's natural anatomy. In addition, 3D printed scaffolds facilitate tissue engineering, potentially favoring the development and integration of autologous adipose tissue, thus avoiding implant-related complications. Postoperatively, 3D imaging allows an accurate assessment of breast volume and symmetry, which is crucial in assessing the success of reconstruction. The technology is also a key educational tool, enhancing surgeon training through realistic anatomical models and surgical simulations. As the field evolves, the integration of 3D printing with emerging technologies such as biodegradable materials and advanced imaging promises to further refine breast reconstruction techniques and outcomes. This study aims to explore the various applications of 3D printing in breast reconstruction, addressing current challenges and future opportunities.

Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients

BACKGROUND

Implant-based breast reconstruction is easy to be performed but has flaws that an unnatural appearance might be presented when no sufficient coverage existing. While autologous tissue reconstruction also has disadvantages like donor site scar and skin patch effect. There is a demand for a new method to obtain natural and aesthetic appearance while surmounting drawbacks of conventional breast reconstruction surgery.

METHODS

A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the volume symmetry of bilateral breasts. The BREAST-Q reconstruction module was used to evaluate the satisfaction.

RESULTS

The mean endoscopic LDMF harvest time was 90.4 min. In the mean follow-up of 11.2 months, there were no severe capsular contracture happened. The reconstructed side achieved good volume symmetry to the contralateral side (P = 0.256). Based on the evaluation of the BREAST-Q scores, the outcome of Satisfaction with Breasts was excellent or good in 87.1% of the cases.

CONCLUSIONS

The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, while require short time for LDMF harvest and present low incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.