A multidisciplinary approach for autologous breast reconstruction: A narrative (re)view for better management

A Delphi study and International Consensus Recommendations: The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer

“…The mastectomy superficial margin is usually not reported [45,46]. However, due to incomplete resection of the glandular tissue or as a result of the normal breast glands ''sawtooth" extensions into the subcutis, DCIS may be present at the anterior margins or in case of nipple sparing mastectomy (NSM), DCIS may even be present as a skip lesion in the ducts in the nipple core [47][48][49][50][51][52]. Additionally, extensive intraductal component-positive carcinomas were shown to be associated with an increased risk of local recurrence when the surgical margins were not evaluated (e.g., anterior margin) or focally involved [45, [52][53][54][55].…”

The risk of reconstruction failure following a mastectomy, breast reconstruction and radiotherapy depending on the reconstruction technique

“…Why do oncological centres in the majority of cases perform an implant reconstruction if radiotherapy is planned in spite of scientific evidence pointing to a lower risk of complications following autologous reconstructions? This is especially the case since autologous reconstructions keep evolving significantly, and together with progress in microsurgery, this allows for a further decrease in the complication rate in the donor site and reconstruction area [15]. It seems that as much as the rate of complications influences the type of reconstruction planning, the final decision depends also on other factors, such as the preferences of the surgeon concerning the treatment technique, the patient's preferences with respect to the method and her approval of a higher risk for a selected method, the possibilities of complex plastic surgeries in TE -expander; I -permanent implant; AR autologous reconstruction; RT -radiotherapy; OR -odds ratio; TE/I -> RT -first immediate reconstruction with expander/implant, followed by radiotherapy; AR -> RT -first immediate autologous reconstruction, followed by radiotherapy; RT -> TE/I -radiotherapy during primary oncological treatment followed by delayed reconstruction with an implant; RT -> AR -radiotherapy during primary oncological treatment followed by delayed autologous reconstruction; TE -> RT -> I -2-stage immediate reconstruction with radiotherapy onto the expander, followed by exchange into permanent implant; TE -> RT -> AR -2-stage immediate reconstruction with radiotherapy onto the expander, and in the second stage -autologous reconstruction; I -> RT -1-stage immediate reconstruction with radiotherapy onto the permanent implant An advantage of an autologous reconstruction is the natural look of the breasts, natural contours and inframammary fold, the natural position of the nipple-areolar complex, a lower rate of complications and increased patient satisfaction with the surgery followed by radiotherapy after long-term follow-up [13,14,53,59,63].…”

“…It seems that as much as the rate of complications influences the type of reconstruction planning, the final decision depends also on other factors, such as the preferences of the surgeon concerning the treatment technique, the patient's preferences with respect to the method and her approval of a higher risk for a selected method, the possibilities of complex plastic surgeries in TE -expander; I -permanent implant; AR autologous reconstruction; RT -radiotherapy; OR -odds ratio; TE/I -> RT -first immediate reconstruction with expander/implant, followed by radiotherapy; AR -> RT -first immediate autologous reconstruction, followed by radiotherapy; RT -> TE/I -radiotherapy during primary oncological treatment followed by delayed reconstruction with an implant; RT -> AR -radiotherapy during primary oncological treatment followed by delayed autologous reconstruction; TE -> RT -> I -2-stage immediate reconstruction with radiotherapy onto the expander, followed by exchange into permanent implant; TE -> RT -> AR -2-stage immediate reconstruction with radiotherapy onto the expander, and in the second stage -autologous reconstruction; I -> RT -1-stage immediate reconstruction with radiotherapy onto the permanent implant An advantage of an autologous reconstruction is the natural look of the breasts, natural contours and inframammary fold, the natural position of the nipple-areolar complex, a lower rate of complications and increased patient satisfaction with the surgery followed by radiotherapy after long-term follow-up [13,14,53,59,63]. The downsides of autologous surgeries comprise: • more extensive type of surgery, • the level of technical difficulty, • frequent numerous stages of surgery, • more pain, • requirement of a surgical team performing microvascular anastomoses, • longer recovery period, • possible complications of the donor site and reconstruction site, • it is a more expensive procedure than implant reconstruction; and in the case of reconstruction failure, there is little chance of salvage surgery with the use of the patient's own tissues [15,31,33,60].…”

“…Autologous reconstructions employ musculocu-taneous pedicled or free flaps, which require microvascular anastomoses. The most frequently used flaps comprise DIEP (deep inferior epigastric artery perforator free flap), TRAM (transverse rectus abdominis musculocutaneous pedicled flap), LD (latissimus dorsi musculocutaneous pedicled flap) and SGAP (gluteal musculocutaneous free flap) [13][14][15][16][17][18]. Autologous reconstructions comprise also autologous fat grafting.…”

Tricks and tips for target volume definition and delineation in breast cancer: Lessons learned from ESTRO breast courses

“…Following skin sparing/nipple sparing mastectomy, the target volume includes any residual breast tissue and the subcutaneous layer of the native skin breast which is preserved as part of the skin sparing mastectomy procedure. [17,18]…”