Introduction to prosthetic breast reconstruction

Introduction

Since the previous edition of this text, there have been significant advancements and setbacks when it comes to prosthetic breast reconstruction. One of the most notable advancements has been the technique of prepectoral placement of prosthetic devices that has now become an acceptable option for prosthetic breast reconstruction. On the other hand, a significant setback has occurred when it comes to the availability of certain prosthetic devices due to concerns about the evolving entity of anaplastic large cell lymphoma (ALCL) that has been associated with the use of textured surface breast implants. Other evolving concerns include the phenomena of breast implant illness (BII) and the use of surgical mesh materials to facilitate prosthetic breast reconstruction. Despite this, prosthetic breast reconstruction continues to be the most common form of breast reconstruction offered to women following mastectomy.

The era of the bioengineered breast has evolved and our ability to optimize aesthetic outcomes has been elevated. Strategies to achieve this are varied and include the use of tissue expanders and implants, use of acellular dermal matrix, use of round or shaped devices, placement of devices above or below the pectoralis major muscle, and the use of fat grafting. This introductory chapter will review the salient aspects and advancements of prosthetic reconstruction in preparation for a more detailed description in subsequent chapters.

Anaplastic large cell lymphoma

The controversy surrounding ALCL is arguably one of the most significant issues surrounding prosthetic breast reconstruction. The link between textured surface breast implants and ALCL has been extensively debated between governmental agencies, industry representatives, plastic surgeons and patient advocacy groups. These debates have ultimately resulted in the voluntary withdrawal of macrotextured breast implants by Allergan. Fortunately, the incidence of ALCL is low (in the range of 1 in every 2000–3000 patients); however, this estimate is continually changing. In response, there has been an increase in the use of smooth surface breast implants because, to date, there has been no case of ALCL in a patient who has only had a smooth breast implant. As such, smooth implant technology continues to evolve to minimize soft tissue inflammation and optimize the interaction between the body and the device. This phenomenon of ALCL will be extensively updated in a subsequent chapter.