Breast Reconstructive Options

*Benjamin Liliav and Luis Torres-Strauss*

#### **Abstract**

Breast reconstructive options have evolved over the past six decades. Despite advancements in technology, improved therapeutic options, and genetic testing, women are still, unfortunately, faced with a myriad of deformities after treatments for breast cancer. In order to restore an esthetically pleasing breast mound, a careful evaluation of the patient must be taken into account. There are, generally, three components or factors that need to be considered while devising an excellent reconstructive option for a particular patient. These are: patient factors, surgeons' factors, and oncologic factors. It is only with a detailed understanding of each one of these factors that a sound solution is arrived at. In this chapter, we will explore the various modalities of breast reconstruction available to patients. We will also demonstrate specific considerations in order to optimize an excellent outcome for our breast cancer patients.

**Keywords:** breast reconstruction, breast cancer, implant based reconstruction, autologous reconstruction, lipofilling of breast, fat grafting breast, advances, and trends in reconstruction of the breast

#### **1. Introduction**

Breast cancer (BC) is the most common cancer of women in the United States and worldwide [1, 2]. The management of BC is in constant evolution. Multiple landmark studies published in the last several decades have led to a transition from a more radical surgical approach towards breast conserving surgery and less deforming mastectomies [3–7] (**Figure 1**). Similarly, the field of breast reconstruction (BR) has seen many changes in the form of new knowledge and technical advancements that have led to the development of modern reconstructive practices for restoration of a breast mound.

The surgical treatment of BC is best achieved in a multidisciplinary approach [8–10]. The patient typically requires the expertise of many medical and surgical specialists as part of their collaborative treatment plan. Adjuvant therapies in the form of chemotherapy, radiation therapy, hormonal therapy, biologic therapy, and psychologic therapies, may be required for optimal treatment of BC patients. For those undergoing a surgical treatment, reconstruction should be an integral part of the treatment plan as well. The goal of BR is to restore an esthetically pleasing breast mound. With many recent advancements in knowledge and surgical techniques, the ability to restore a cosmetically appealing breast utilizing BR has evolved into its modern practice.

The female breast is the most revered symbol of femininity. From physiological stand point, the breasts main function is lactation. From an anatomical perspective,

#### **Figure 1.** *Evolution of breast cancer surgery.*

they serve as a crucial part of the female body image and sexuality [11]. Breast oncologic surgery for the treatment of BC may lead to anatomic deformities with the consequence of adverse impact on the patient's quality of life [12]. Many studies have shown the psychologic and therapeutic benefits in women who undergo BR [13]. The breast restoration experience has been shown not only to reinstate the esthetically pleasing breast but also to improve the personal body image in these women [14].

When a BC patient undergoes a surgical treatment for a tumor, it may result in breast deformities or the complete acquired absence of a breast.

#### **Figure 2.**

*48 year old female after lumpectomy and radiation to her right breast. Volume distortion and contour abnormality is clearly visible in the right breast compared with left.*

**Figure 3.** *32 year old female after right mastectomy with total acquired breast absence.*

With breast conserving therapy, which entails lumpectomy and radiation, several breast contour deformities and volume distortion may result from tumor excision and radiation treatment (**Figure 2**) [15, 16].

In patients undergoing mastectomy either as a Skin Sparing Mastectomy (SSM) or a Nipple Sparing Mastectomy (NSM), the result is a patient with acquired breast absence (**Figure 3**). In order to offset these deformities, and optimize the surgical outcome, the patient should be informed of reconstructive options prior to undergoing the lumpectomy or mastectomy procedures. Therefore, it is absolutely imperative to involve the reconstructive plastic surgeon as part of the multidisciplinary team as soon as the diagnosis for BC is made. This will allow the patient to have access to and be carefully evaluated by the reconstructive plastic surgeon and help determine what breast restoration options are available to the patient early in the treatment process.
