One-Stage Immediate Breast Reconstruction: A Concise Review

Abstract

Background One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness. Material and Methods We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM), synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications. Results IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life. Conclusions IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection.

The science behind autologous fat grafting

“…In plastic surgery, lipofilling is widely used in breast augmentation and reconstruction [96] , [97] , [98] , [99] , [100] , [101] and in volume and contour deformities of the trunk [102] , [103] , [104] and lower limbs [105] , [106] .…”

Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

“…For these reasons, patients should be informed, and this multimodality approach planned within a proper timing. In the past, IBR with implants after radiation therapy or in prevision of PMRT was felt to be contraindicated due to the reported high incidence rate of CC, and in general of skin complications [53]. Although outcomes after IBR following mastectomy is considered safe, limited oncologic data is available if PMRT is planned.…”

Comparison of surgical complication between immediate implant and autologous breast reconstruction after mastectomy: A multicenter study of 426 cases

“…During the past decade IBR after mastectomy, which brings patients with BC improved aesthetic and psychological outcome, has been gaining popularity worldwide . However, there are few reports of breast reconstruction in Chinese patients with BC due to the deep‐rooted traditional concepts toward BC and the low demand for aesthetic outcomes in Chinese women.…”