AI Article Synopsis

  • Breast reconstruction using microsurgical techniques offers safer autologous options post-mastectomy, with significant advancements leading to various personalized choices based on patient needs and aesthetic goals.
  • A literature review highlighted the importance of patient selection for successful outcomes, identifying abdominal free flaps as the gold standard, while also noting reliable alternatives for those who may not be ideal candidates.
  • The study found that the success rate for reconstruction and flap viability exceeds 95%, emphasizing the need for individualized risk assessments, though some relative contraindications, like obesity, can affect eligibility.

Article Abstract

Background And Objective: Breast reconstruction with microsurgical techniques allows for autologous reconstruction after mastectomy without the complications associated with alloplastic reconstruction. Autologous reconstruction has undergone significant improvement and now offers patients a variety of options depending on patient specific factors and aesthetic outcomes. This review aims to focus on the history of autologous reconstruction, operative considerations, general surgical techniques for flaps, and indications for choosing the ideal free tissue transfer for all medical specialties and not only plastic surgeons.

Methods: A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to history of microsurgical options, surgical techniques, patient considerations, and contraindications were utilized for this review with the objective to simplify data for all non-plastic surgeon readers.

Key Content And Findings: In this study, we find that patient selection is critical in successful outcomes for microsurgical breast reconstruction. We find that abdominal free flaps are now considered gold standard for autologous reconstruction. However, reliable alternatives exist for patients who are not considered ideal candidates for this reconstruction. These include thigh-based flaps such as gracilis myocutaneous flaps, profunda artery perforator flaps, lateral thigh perforator flaps and trunk-based flaps such as lumbar artery perforator flap. Postoperative considerations involve clinical monitoring and enhanced recovery after surgery. The rate of reconstructive success and flap viability is greater that 95%, even in high-risk populations, and therefore risk stratification should be performed based on an individual basis. While there are no absolute contraindications to autologous reconstruction, relative contraindications do exist including obesity and elderly populations due to the increased surgical and medical complications.

Conclusions: While implant-based reconstruction remains the predominant method of breast reconstruction in the United States, there have been many exciting advancements in autologous reconstruction that offers high aesthetic outcomes and patient satisfaction.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399014PMC
http://dx.doi.org/10.21037/gs-24-63DOI Listing

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