Update in Implant-Based Breast Reconstruction

Sebastian J. Winocour, MD, MSc, FACS

Implant-based techniques represent the most common means of reconstruction after mastectomy. Over the last decade, new developments in implant technology, surgical technique, and bioprosthetic or synthetic adjuncts have enhanced the predictability and outcomes after implant-based reconstruction. Objective methods of mastectomy skin flap perfusion assessment have the potential to further improve surgical outcomes. The last five years have also witnessed a renewed and transformative interest in prepectoral prosthetic placement, facilitated by the availability of bioprosthetic materials for pocket control and device coverage. Together, these developments are advancing the boundaries of implant-based strategies for breast reconstruction, including reconstruction in the setting of challenging frontiers such as postmastectomy radiation, direct-to-implant reconstruction, and nipple-sparing mastectomies.

Growth in our experience with implants for breast reconstruction has also been coupled with increased recognition of implant-related pathologies. Heightened awareness of the entity of breast implant–associated anaplastic large cell lymphoma, its pathophysiology, diagnosis, and treatment over the recent years, both within the medical arena and amongst public sectors, is profoundly altering the practice of implant selection globally. With the priority of patient safety being foremost, plastic surgeons must stay abreast of the ongoing research and evolving recommendations on this subject matter.

Therefore, it is with great excitement that I present this issue of Seminars in Plastic Surgery focused on updates in implant-based breast reconstruction. It has been an honor to have the opportunity to collaborate with so many talented surgeons who have contributed their expertise to this collective body of work. I hope the readers will find the content useful and timely.