Update und Trends bei der plastisch-chirurgischen Brustrekonstruktion nach Mastektomie

Zusammenfassung

Dank der Verfeinerung der Operationstechniken ist die autologe Brustrekonstruktion inzwischen Teil der Standardversorgung geworden. Die Beratung der Patientinnen ist aufgrund der Erweiterung der onkologischen Möglichkeiten zur Mastektomie, Brusterhalt und Strahlentherapie und der Vielzahl der rekonstruktiven Techniken schwieriger geworden. Ziel der Rekonstruktion ist es, tumorzellfreie Resektionsränder und ein langfristig ästhetisch zufriedenstellendes Ergebnis mit hoher Lebensqualität für die Patientin zu erreichen. Bei der sofortigen Rekonstruktion ermöglicht die hautsparende oder sogar mamillensparende Mastektomie den Erhalt der Brusthaut und ihrer natürlichen Form, welches das mit der Mastektomie verbundene psychologische Trauma deutlich verringert. Jedoch weisen sekundäre Rekonstruktionen oft eine höhere Zufriedenheit auf, da hier seitens der Patientinnen nach erlebter Formveränderung keine Restitutio ad integrum angenommen wird. Dieser Artikel gibt einen Überblick über die aktuellen Möglichkeiten der Brustrekonstruktion und eine Betrachtung der Patientinnen-Zufriedenheit und Lebensqualität nach einer Brustrekonstruktion. Obwohl die meisten Patientinnen und Chirurg*innen nach wie vor die sofortige Rekonstruktion bevorzugen, scheint eine Verzögerung der Rekonstruktion die klinischen oder von den Patientinnen berichteten Ergebnisse nicht zu beeinträchtigen. Zu den neuesten Verfeinerungen der chirurgischen Techniken und der autologen Brustrekonstruktion gehören „stacked-flaps“, sowie mikrochirurgische Nervenkoaptation zur Wiederherstellung der Sensibilität, welche zu einer Verbesserung des Ergebnisses und der Lebensqualität führen. Heterologe, d. h. Implantat basierte, Brustrekonstruktion und autologe Brustrekonstruktion sind mittlerweile komplementäre Techniken. Neue Techniken wie die hautsparende und mamillensparende Mastektomie, begleitet von verbesserter Implantatqualität, ermöglichen heutzutage eine risikoarme sofortige prothetische Brustrekonstruktion mit präpektoraler Implantatlage. Die Wahl der Brustrekonstruktion ist abhängig von der Art der Mastektomie, etwaiger Bestrahlung, individuellen Risikofaktoren, dem Habitus und den Wünschen der Patientin. Insgesamt führen die neuerlichen Entwicklungen in der Brustrekonstruktion zu einer Erhöhung der Patientinnen-Zufriedenheit, Lebensqualität, des ästhetischen Ergebnisses unter onkologischer Sicherheit.

Abstract

Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. It has become more difficult to advise patients due to the expansion of oncologic options for mastectomy, radiation therapy and the variety of reconstructive techniques. The goal of reconstruction is to achieve oncologically clear margins and a long-term aesthetically satisfactory result with a high quality of life. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. However, secondary reconstructions often have a higher satisfaction, since here no restitutio ad integrum is assumed. Alloplastic, i. e., implant-based, breast reconstruction and autologous breast reconstruction are complementary techniques. This article provides an overview of current options for breast reconstruction including patients’ satisfaction and quality of life following breast reconstruction. Although immediate reconstruction is still the preferred choice of most patients and surgeons, delayed reconstruction does not appear to compromise clinical or patient-reported outcomes. Recent refinements in surgical techniques and autologous breast reconstruction include stacked-flaps, as well as microsurgical nerve coaptation to restore sensitivity, which lead to improved outcomes and quality of life. Nowadays Skin-sparing and nipple-sparing mastectomy, accompanied by improved implant quality, allows immediate prosthetic breast reconstruction as well as reemergence of the prepectoral implantation. The choice of breast reconstruction depends on the type of mastectomy, necessary radiation, individual risk factors, as well as the patient's habitus and wishes. Overall, recent developments in breast reconstruction led to an increase in patient satisfaction, quality of life and aesthetic outcome with oncological safety.

Schlüsselwörter

Brustchirurgie - Mammarekonstruktion - Brustimplantate - Brust

Key words

breast surgery - breast reconstruction - breast implants - breast

Publication History

Received: 19 February 2022

Accepted: 15 February 2023

Article published online:
24 July 2023

• Literatur

• 1 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209-249
• 2 European cancer information system.ECIS. Breast cancer burden in EU-27 2020. Jt Res Cent 2020: 44–45. Im Internet: https://www.encr.eu/sites/default/files/factsheets/Breast_cancer_factsheet_December_2020.pdf
• 3 Gerber B, Marx M, Untch M. et al. Breast Reconstruction Following Cancer Treatment. Dtsch Arztebl Int 2015; 112: 593-600
• 4 Wong SM, Freedman RA, Sagara Y. et al. Growing use of contralateral prophylactic mastectomy despite no improvement in long-term survival for invasive breast cancer. Ann Surg 2017; 265: 581-589
• 5 Kummerow KL, Du L, Penson DF. et al. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg 2015; 150: 9-16
• 6 AWMF Leitlinienprogramm, Mammakarzinom. Interdisziplinäre S3-Leitlinie für die Früherkennung , Nachsorge des Mammakarzinoms. 2019
• 7 Santosa KB, Qi J, Kim HM. et al. Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction. JAMA Surg 2018; 153: 891-899
• 8 Holoyda KA, Magno-Padron DA, Carter GC. et al. National Trends in Length of Stay for Microvascular Breast Reconstruction: An Evaluation of 10,465 Cases Using the American College of Surgeons National Surgical Quality Improvement Program Database. Plast Reconstr Surg 2022; 149: 306-313
• 9 Tanos G, Prousskaia E, Chow W. et al. Locally Advanced Breast Cancer: Autologous Versus Implant-based Reconstruction. Plast Reconstr surgery Glob open 2016; 4: e622
• 10 Cordeiro PG, Jazayeri L. Two-Stage Implant-Based Breast Reconstruction: An Evolution of the Conceptual and Technical Approach over a Two-Decade Period. Plast Reconstr Surg 2016; 138: 1-11
• 11 Walia GS, Aston J, Bello R. et al. Prepectoral versus subpectoral tissue expander placement: A clinical and quality of life outcomes study. Plast Reconstr Surg - Glob Open 2018; 6: 1-6
• 12 Schlenker JD, Bueno RA, Ricketson G. et al. Loss of silicone implants after subcutaneous mastectomy and reconstruction. Plast Reconstr Surg 1978; 62
• 13 Sigalove S, Maxwell GP, Sigalove NM. et al. Prepectoral implant-based breast reconstruction and postmastectomy radiotherapy: Short-term outcomes. Plast Reconstr Surg - Glob Open 2017; 5: 1-7
• 14 Alnaif N, Safran T, Viezel-Mathieu A. et al. Treatment of breast animation deformity: A systematic review. J Plast Reconstr Aesthetic Surg 2019; 72: 781-788
• 15 Rebowe RE, Allred LJ, Nahabedian MY. The evolution from subcutaneous to prepectoral prosthetic breast reconstruction. Plast Reconstr Surg - Glob Open 2018; 6: 1-8
• 16 Salgarello M, Visconti G, Barone-Adesi L. Current trends in breast reconstruction. Minerva Surg 2021; 76: 526-537
• 17 ASPS National Clearinghouse of Plastic Surgery Procedural Statistics; Plastic Surgery Statistics Report 2020. 2021. Im Internet: https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf
• 18 Broyles JM, Liao EC, Kim J. et al. Acellular Dermal Matrix-Associated Complications in Implant-Based Breast Reconstruction: A Multicenter, Prospective, Randomized Controlled Clinical Trial Comparing Two Human Tissues. Plast Reconstr Surg 2021; 493-500
• 19 Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg 2005; 55: 232-239
• 20 Campbell CA, Losken A. Understanding the Evidence and Improving Outcomes with Implant-Based Prepectoral Breast Reconstruction. Plast Reconstr Surg 2021; 437E-450E
• 21 Colwell AS, Taylor EM. Recent Advances in Implant-Based Breast Reconstruction. Plast Reconstr Surg 2020; 145: 421e-432e
• 22 Sbitany H, Serletti JM. Acellular dermis-assisted prosthetic breast reconstruction: A systematic and critical review of efficacy and associated morbidity. Plast Reconstr Surg 2011; 128: 1162-1169
• 23 Parikh RP, Brown GM, Sharma K. et al. Immediate implant-based breast reconstruction with acellular dermal matrix: A comparison of sterile and aseptic alloderm in 2039 consecutive cases. Plast Reconstr Surg 2018; 142: 1401-1409
• 24 Hallberg H, Rafnsdottir S, Selvaggi G. et al. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg 2018; 52: 130-147
• 25 Maisel Lotan A, Ben Yehuda D, Allweis TM. et al. Comparative Study of Meshed and Nonmeshed Acellular Dermal Matrix in Immediate Breast Reconstruction. Plast Reconstr Surg 2019; 144: 1045-1053
• 26 Lohmander F, Lagergren J, Roy PG. et al. Implant Based Breast Reconstruction with Acellular Dermal Matrix: Safety Data from an Open-label, Multicenter, Randomized, Controlled Trial in the Setting of Breast Cancer Treatment. Ann Surg 2019; 269: 836-841
• 27 Ho G, Nguyen TJ, Shahabi A. et al. A systematic review and meta-analysis of complications associated with acellular dermal matrix-assisted breast reconstruction. Ann Plast Surg 2012; 68: 346-356
• 28 Kearney AMM, Yan Y, Bricker JT. et al. Acellular Dermal Matrix-Associated Contracture: A Clinical and Histologic Analysis of Patients Undergoing Prosthetic Breast Reconstruction. Plast Reconstr Surg 2021; 968-977
• 29 Lardi AM, Ho-Asjoe M, Mohanna P-N. et al. Immediate breast reconstruction with acellular dermal matrix: factors affecting outcome. J Plast Reconstr Aesthetic Surg 2014; 67: 1098-1105
• 30 Hillberg NS, Ferdinandus PI, Dikmans REG. et al. Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?: Strattice^TM or Meso Biomatrix® in SSBR. Eur J Plast Surg 2018; 41: 429-438
• 31 Gdalevitch P, Ho A, Genoway K. et al. Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: Predictors of failure. Plast Reconstr Surg 2014; 133: 738-747
• 32 Nahabedian MY. Prosthetic Breast Reconstruction and Red Breast Syndrome: Demystification and a Review of the Literature. Plast Reconstr Surg - Glob Open 2019; 7: E2108
• 33 Crisera CA, Chang EI, Da Lio AL. et al. Immediate free flap reconstruction for advanced-stage breast cancer: is it safe?. Plast Reconstr Surg 2011; 128: 32-41
• 34 Nedumpara T, Jonker L, Williams MR. Impact of immediate breast reconstruction on breast cancer recurrence and survival. Breast 2011; 20: 437-443
• 35 DGGG. Deutsche Gesellschaft für Gynäkologie und Geburtshilfe; AWMF-Leitlinie S3 015/075; Brustrekonstruktion mit Eigengewebe 2015; 1-253
• 36 Billig J, Jagsi R, Qi J. et al. Should immediate autologous breast reconstruction be considered in women who require post-mastectomy radiation therapy? A prospective analysis of outcomes. Plast Reconstr Surg 2017; 139: 1279
• 37 Baumann DP, Crosby MA, Selber JC. et al. Optimal timing of delayed free lower abdominal flap breast reconstruction after postmastectomy radiation therapy. Plast Reconstr Surg 2011; 127: 1100-1106
• 38 Lee BT A, Adesiyun T, Colakoglu S. et al. Postmastectomy Radiation Therapy and Breast Reconstruction: An Analysis of Complications and Patient Satisfaction. Ann Plast Surg 2010; 64
• 39 Sekiguchi K, Kawamori J, Yamauchi H. Breast reconstruction and postmastectomy radiotherapy: complications by type and timing and other problems in radiation oncology. Breast Cancer 2017; 24: 511-520
• 40 Claßen J, Nitzsche S, Wallwiener D. et al. Fibrotic changes after postmastectomy radiotherapy and reconstructive surgery in breast cancer. Strahlentherapie und Onkol 2010; 186: 630-636
• 41 Patel KM, Albino F, Fan KL. et al. Microvascular autologous breast reconstruction in the context of radiation therapy: comparing two reconstructive algorithms. Plast Reconstr Surg 2013; 132: 251-257
• 42 Carlson GW, Page AL, Peters K. et al. Effects of radiation therapy on pedicled transverse rectus abdominis myocutaneous flap breast reconstruction. Ann Plast Surg 2008; 60: 568-572
• 43 Tran NV, Chang DW, Gupta A. et al. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 2001; 108: 78-82
• 44 Fracol ME, Basta MN, Nelson JA. et al. Bilateral Free Flap Breast Reconstruction After Unilateral Radiation: Comparing Intraoperative Vascular Complications and Postoperative Outcomes in Radiated Versus Nonradiated Breasts. Ann Plast Surg 2016; 76: 311-314
• 45 Hershenhouse KS, Bick K, Shauly O. et al. “Systematic review and meta-analysis of immediate versus delayed autologous breast reconstruction in the setting of post-mastectomy adjuvant radiation therapy”. J Plast Reconstr Aesthetic Surg 2021; 74: 931-944
• 46 Gurunluoglu R, Gurunluoglu A, Williams SA. et al. Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. Ann Plast Surg 2013; 70: 103-110
• 47 Fujimoto H, Ishikawa T, Satake T. et al. Donor site selection and clinical outcomes of nipple–areola skin-sparing mastectomy with immediate autologous free flap reconstruction: A single-institution experience. Eur J Surg Oncol 2016; 42: 369-375
• 48 Patel NG, Ramakrishnan V. Microsurgical tissue transfer in breast reconstruction. Clin Plast Surg 2020; 47: 595-609
• 49 Papp C, Windhofer C, Gruber S. Breast reconstruction with the fasciocutaneous infragluteal free flap (FCI). Ann Plast Surg 2007; 58: 131-136
• 50 Saad A, Sadeghi A, Allen RJ. The anatomic basis of the profunda femoris artery perforator flap: a new option for autologous breast reconstruction—a cadaveric and computer tomography angiogram study. J Reconstr Microsurg 2012; 28: 381-386
• 51 Jo T, Jeon DN, Han HH. The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients. J Reconstr Microsurg 2021; 38: 27-33
• 52 Roy PG, Mustata L, Hu J. et al. Partial Breast Reconstruction with Lateral Chest Wall Perforator Flap to Facilitate Breast Conservation in Breast Cancer: First 100 Cases with Cancer Outcomes at 8 Years Follow-Up and the Lessons Learned. Cancer Manag Res 2021; 13: 9453-9466
• 53 Mayo JL, Allen RJ, Sadeghi A. Four-flap Breast Reconstruction: Bilateral Stacked DIEP and PAP Flaps. Plast Reconstr surgery Glob open 2015; 3: e383
• 54 Murray A, Wasiak J, Rozen WM. et al. Stacked abdominal flap for unilateral breast reconstruction. J Reconstr Microsurg 2015; 31: 179-186
• 55 Tessler O, Guste J, Bartow MJ. et al. Stacked Lateral Thigh Perforator Flap as a Novel Option for Autologous Breast Reconstruction. Plast Reconstr Surg 2019; 143: 1601-1604
• 56 Haddock NT, Suszynski TM, Teotia SS. Consecutive Bilateral Breast Reconstruction Using Stacked Abdominally Based and Posterior Thigh Free Flaps. Plast Reconstr Surg 2021; 147: 294-303
• 57 Blondeel PN, Demuynck M, Mete D. et al. Sensory nerve repair in perforator flaps for autologous breast reconstruction: sensational or senseless?. Br J Plast Surg 1999; 52: 37-44
• 58 Tindholdt TT, Tønseth KA. Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction. Scand J Plast Reconstr Surg hand Surg 2008; 42: 28-31
• 59 Spiegel AJ, Menn ZK, Eldor L. et al. Breast reinnervation: DIEP neurotization using the third anterior intercostal nerve. Plast Reconstr Surg 2013; 1: 1-9
• 60 Zhou A, Ducic I, Momeni A. Sensory restoration of breast reconstruction – The search for the ideal approach continues. J Surg Oncol 2018; 118: 780-792
• 61 Beugels J, Cornelissen AJM, van Kuijk SMJ. et al. Sensory Recovery of the Breast following Innervated and Noninnervated DIEP Flap Breast Reconstruction. Plast Reconstr Surg 2019; 144: 178e-188e
• 62 Cornelissen AJM, Beugels J, van Kuijk SMJ. et al. Sensation of the autologous reconstructed breast improves quality of life: A pilot study. Breast Cancer Res Treat 2018; 167: 687-695
• 63 Mori H, Okazaki M. Is the sensitivity of skin-sparing mastectomy or nipple-sparing mastectomy superior to conventional mastectomy with innervated flap?. Microsurgery 2011; 31: 428-433
• 64 Browne JP, Jeevan R, Gulliver-Clarke C. et al. The association between complications and quality of life after mastectomy and breast reconstruction for breast cancer. Cancer 2017; 123: 3460-3467
• 65 Yoon AP, Qi J, Brown DL. et al. Outcomes of immediate versus delayed breast reconstruction: results of a multicenter prospective study. The Breast 2018; 37: 72-79
• 66 Erdmann-Sager J, Wilkins EG, Pusic AL. et al. Complications and patient-reported outcomes after abdominal-based breast reconstruction: results of the Mastectomy Reconstruction Outcomes Consortium (MROC) study. Plast Reconstr Surg 2018; 141: 271
• 67 Wei CH, Scott AM, Price AN. et al. Psychosocial and sexual well-being following nipple-sparing mastectomy and reconstruction. Breast J 2016; 22: 10-17
• 68 Egan KG, Cullom M, Nazir N. et al. Patient Satisfaction Increases with Nipple Reconstruction following Autologous Breast Reconstruction. Plast Reconstr Surg 2021; 177E-184E
• 69 Toyserkani NM, Jørgensen MG, Tabatabaeifar S. et al. Autologous versus implant-based breast reconstruction: A systematic review and meta-analysis of Breast-Q patient-reported outcomes. J Plast Reconstr Aesthetic Surg 2020; 73: 278-285
• 70 Le NK, Persing S, Dinis J. et al. A Comparison of BREAST-Q Scores between Prepectoral and Subpectoral Direct-to-Implant Breast Reconstruction. Plast Reconstr Surg 2021; 148: 708e-714e
• 71 Shamsunder MG, Polanco TO, McCarthy CM. et al. Understanding preoperative breast satisfaction among patients undergoing mastectomy and immediate reconstruction: BREAST-Q insights. Plast Reconstr Surg 2021; 148: 891E-902E
• 72 Hanson SE, Kapur SK, Hwang RF. et al. Autologous fat grafting in breast reconstruction: implications for follow-up and surveillance. Gland Surg 2021; 10: 487-493
• 73 De Decker M, De Schrijver L, Thiessen F. et al. Breast cancer and fat grafting: efficacy, safety and complications—a systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 207: 100-108
• 74 Groen JW, Negenborn VL, Twisk DJWR. et al. Autologous fat grafting in onco-plastic breast reconstruction: A systematic review on oncological and radiological safety, complications, volume retention and patient/surgeon satisfaction. J Plast Reconstr Aesthetic Surg 2016; 69: 742-764
• 75 Kaoutzanis C, Xin M, Ballard TNS. et al. Autologous fat grafting after breast reconstruction in postmastectomy patients complications, biopsy rates, and locoregional cancer recurrence rates. Ann Plast Surg 2016; 76: 270-275
• 76 Sommeling CE, Van Landuyt K, Depypere H. et al. Composite breast reconstruction: Implant-based breast reconstruction with adjunctive lipofilling. J Plast Reconstr Aesthetic Surg 2017; 70: 1051-1058
• 77 Abboud MH, El Hajj H, Kapila AK. et al. Scarless Composite Breast Reconstruction Utilizing an Advancement Skin Flap, Loops, and Lipofilling. Aesthetic Surg J 2022; 42: 38-53
• 78 Eccles SA, Aboagye EO, Ali S. et al. Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer. Breast Cancer Res 2013; 15: 1-37
• 79 Cutress RI, McIntosh SA, Potter S. et al. Opportunities and priorities for breast surgical research. Lancet Oncol 2018; 19: e521-e533
• 80 O’Halloran N, Potter S, Kerin M. et al. Recent Advances and Future Directions in Postmastectomy Breast Reconstruction. Clin Breast Cancer 2018; 18: e571-e585
• 81 O’Halloran N, Courtney D, Kerin MJ. et al. Adipose-Derived Stem Cells in Novel Approaches to Breast Reconstruction: Their Suitability for Tissue Engineering and Oncological Safety. Breast Cancer Basic Clin Res 2017; 11
• 82 Ryu H, Oh JE, Rhee KJ. et al. Adipose tissue-derived mesenchymal stem cells cultured at high density express IFN-β and suppress the growth of MCF-7 human breast cancer cells. Cancer Lett 2014; 352: 220-227
• 83 Martin-Padura I, Gregato G, Marighetti P. et al. The white adipose tissue used in lipotransfer procedures is a rich reservoir of CD34+progenitors able to promote cancer progression. Cancer Res 2012; 72: 325-334
• 84 Mu X, Zhang J, Jiang Y. 3D Printing in Breast Reconstruction: From Bench to Bed. Front Surg 2021; 8: 1-11