by Lin Lin Gao, MD
Although the concepts, goals and anatomy pertaining to breast reconstruction may initially seem straightforward, appreciation of the nuances and complexity usually comes with greater experience. The compilation of articles in the Resident Reader helps with understanding of the various techniques and serves as an essential introduction for budding plastic surgeons.
First and foremost, the collection begins with anatomy: Rohrich et al’s primer on perforator-based flaps. It starts with a brief historical perspective, an overview of the perforasome concept and clarifies the nomenclature. It then delves into more detail in describing each of the more commonly used flaps. The high definition pictures and the step-by-step roadmap on the dissection and how to find perforators make it an indispensible reference for raising common flaps.
Serletti et al’s paper provides a thorough overview of main types of breast reconstruction. The consideration it gives to the timing of the procedures and the impact it has on chemoradiotherapy was especially helpful. The expander-implant and autologous techniques described are representative of the authors’ approaches. Notably, the videos give a glimpse of the technical maneuvers of master surgeons.
Evidence-based practice is plain good medicine and the next article, authored by Zhong et al, provides a systematic review of the data published on the outcomes of various techniques to support clinical practice. Of particular importance is the distinction made in the separate reconstruction approaches for radiated versus nonirradiated breasts and the discussion of when to use acellular dermal matrix. In summary, it is an extensive and comprehensive review of the different techniques with many good references, which are often landmark studies.
On the other side of the spectrum of post-mastectomy reconstruction is Losken’s paper discussing partial breast reconstruction. In the systematic approach for reconstruction after breast conservation therapy, he starts with classification scheme and then describes specific technical approaches. He stresses the oncologic soundness of his approach, need for close communication with surgical oncologists and the ease of adapting his methods for surgeons who are familiar with breast reduction techniques.
Blondeel et al’s three-step principle of shaping the breast addresses the less tangible aspects of breast reconstruction that may seem so intuitive for veterans but can be difficult for residents to grasp. It describes three main considerations: 1) breast footprint, 2) conus or the spatial projection of the 3-dimensional geometry and 3) skin envelope. The paper breaks down step-by-step what master surgeons do subconsciously. This is the first of a three part series and although the next two papers are not included in the resident collection, they are also very helpful and worth reading.
In summary, the articles in the Resident Reader on breast reconstruction represent various facets of reconstruction and provide not just an excellent introduction but good starting point to delve deeper. Indeed, it inspires young surgeons to learn more about this fascinating and cutting edge area of plastic surgery and possibly even pursue a career in breast reconstruction.
All articles mentioned in this blog can be conveniently located on the PRS Residents’ Gateway in the The Resident Reader: Reconstruction- Breast Collection