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Handchir Mikrochir Plast Chir 2022; 54(04): 297-304
DOI: 10.1055/a-1808-6779
Übersichtsarbeit

Hybridrekonstruktion der Brust nach Mastektomie

Hybrid Breast Reconstruction Following Mastectomy
Arash Momeni
1   Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, United States
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Zusammenfassung

Die Herausforderung nach Mastektomie ist die sichere Rekonstruktion der Brust von adäquater Größe und Form, welche weich, symmetrisch und sensibel ist („6 S“: size, shape, symmetry, softness, sensation, safety). Traditionell wurden Patientinnen zwei rekonstruktive Verfahren angeboten, nämlich die Implantat-basierte vs. autologe Brustrekonstruktion. Obgleich dieses binäre Vorgehen für die Mehrzahl der Patientinnen adäquat ist, so verbleibt ein Anteil, für welche dieser recht einfache Entscheidungsalgorithmus keine optimale Lösung darstellt. Hier bietet die Hybdridrekonstruktion, d. h. die Kombination von Implantat und mikrochirurgischer Lappenplastik, die Möglichkeit Patientinnen eine individualisierte Rekonstruktion anzubieten, welche die einzelnen Limitationen der traditionellen Verfahren durch Kombination vermeidet. Insofern erweitert die Hybridrekonstruktion das Indikationsspektrum der mikrochirurgischen Brustrekonstruktion und stellt die Vorteile der autologen Brustrekonstruktion einer größeren Patientenpopulation zur Verfügung. In diesem Beitrag wird das operative Vorgehen der Hybridrekonstruktion vorgestellt mitsamt einer Diskussion wichtiger Parameter, inklusive der Implantatloge, Zeitpunkt der Implantatplatzierung, sowie Einfluss der Radiatio.

Abstract

The challenge following mastectomy is to safely reconstruct breasts of adequate size, shape, symmetry, softness, and sensation (“6 S”). Historically, patients have been offered two reconstructive modalities, namely either implant-based or autologous reconstruction. While this binary approach is appropriate for most patients, there remain a subset of patients for whom this simplistic approach is not suitable. For these, hybrid reconstruction, i. e., the combination of an implant with microsurgical tissue transfer, offers the possibility of individualised reconstruction, which avoids some of the limitations of traditional approaches. Hybrid breast reconstruction, thus expands the indications for microsurgical reconstruction and offers the advantages of this reconstructive modality to a larger patient population. In this article, the surgical technique of hybrid breast reconstruction is described, along with a discussion of important parameters related to this reconstructive modality, including plane and timing of implant placement, and the issue of radiotherapy.

Schlüsselwörter

Brustrekonstruktion - Hybridrekonstruktion - Mikrochirurgie - Implantat - freie Lappenplastiken, Mikrochirurgie

Key words

Breast reconstruction - Hybrid reconstruction - microsurgery - breast implant - free flaps


Publication History

Received: 24 January 2022

Accepted: 19 March 2022

Article published online:
22 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 [Anonym]. Deutsche Krebshilfe https://wwwkrebshilfede/informieren/ueber-krebs/krebsarten/brustkrebs/
    PubMed
  • 2 Gerber B, Marx M, Untch M. et al. Breast Reconstruction Following Cancer Treatment. Deutsches Arzteblatt international 2015; 112: 593-600
    CrossrefPubMedSearch in Google Scholar
  • 3 Snyderman RK, Guthrie RH. Reconstruction of the female breast following radical mastectomy. Plast Reconstr Surg 1971; 47: 565-567
    CrossrefPubMedSearch in Google Scholar
  • 4 Santosa KB, Qi J, Kim HM. et al. Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction. JAMA Surg 2018; 153: 891-899
    CrossrefPubMedSearch in Google Scholar
  • 5 Nelson JA, Allen RJ, Polanco T. et al. Long-term Patient-reported Outcomes Following Postmastectomy Breast Reconstruction: An 8-year Examination of 3268 Patients. Ann Surg 2019; 270: 473-483
    CrossrefPubMedSearch in Google Scholar
  • 6 Macadam SA, Zhong T, Weichman K. et al. Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors: A Multicenter Comparison of Four Abdominally Based Autologous Reconstruction Methods. Plast Reconstr Surg 2016; 137: 758-771
    Search in Google Scholar
  • 7 Weber WP, Haug M, Kurzeder C. et al. Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy. Breast Cancer Res Treat 2018; 172: 523-537
    CrossrefPubMedSearch in Google Scholar
  • 8 Bertoni DM, Nguyen D, Rochlin D. et al. Protecting Nipple Perfusion by Devascularization and Surgical Delay in Patients at Risk for Ischemic Complications During Nipple-Sparing Mastectomies. Ann Surg Oncol 2016; 23: 2665-2672
    CrossrefPubMedSearch in Google Scholar
  • 9 Momeni A, Kanchwala S, Sbitany H. Oncoplastic Procedures in Preparation for Nipple-Sparing Mastectomy and Autologous Breast Reconstruction: Controlling the Breast Envelope. Plast Reconstr Surg 2020; 145: 914-920
    CrossrefPubMedSearch in Google Scholar
  • 10 Momeni A, Remington AC, Wan DC. et al. A Matched-Pair Analysis of Prepectoral with Subpectoral Breast Reconstruction: Is There a Difference in Postoperative Complication Rate?. Plast Reconstr Surg 2019; 144: 801-807
    CrossrefPubMedSearch in Google Scholar
  • 11 Momeni A, Kim RY, Heier M. et al. Abdominal Wall Strength: A Matched-Pair Analysis Comparing Muscle-Sparing TRAM Flap Donor-Site Morbidity with the Effects of Abdominoplasty. Plast Reconstr Surg 2010; 126: 1454-1459 [pii]
    CrossrefPubMedSearch in Google Scholar
  • 12 Momeni A, Kanchwala S. Hybrid Prepectoral Breast Reconstruction: A Surgical Approach that Combines the Benefits of Autologous and Implant-Based Reconstruction. Plast Reconstr Surg 2018; 142: 1109-1115
    CrossrefPubMedSearch in Google Scholar
  • 13 Henn D, Momeni A. A standardized patient education class as a vehicle to improving shared decision making and increasing access to breast reconstruction. J Plast Reconstr Aesthet Surg. 2020 Available online 18 February 2020
    PubMedSearch in Google Scholar
  • 14 Li AY, Momeni A. Abdominal Flap-based Breast Reconstruction versus Abdominoplasty: The Impact of Surgical Procedure on Scar Location. Plast Reconstr Surg Glob Open 2020; 8: e3112
    CrossrefPubMedSearch in Google Scholar
  • 15 Serletti JM, Moran SL. The combined use of the TRAM and expanders/implants in breast reconstruction. Ann Plast Surg 1998; 40: 510-514
    CrossrefPubMedSearch in Google Scholar
  • 16 Laporta R, Longo B, Sorotos M. et al. Breast Reconstruction with Delayed Fat-Graft-Augmented DIEP Flap in Patients with Insufficient Donor-Site Volume. Aesthetic Plast Surg 2015; 39: 339-349
    CrossrefPubMedSearch in Google Scholar
  • 17 Zhu L, Mohan AT, Vijayasekaran A. et al. Maximizing the Volume of Latissimus Dorsi Flap in Autologous Breast Reconstruction with Simultaneous Multisite Fat Grafting. Aesthetic surgery journal/the American Society for Aesthetic Plastic surgery 2016; 36: 169-178
    CrossrefPubMedSearch in Google Scholar
  • 18 Stalder MW, Lam J, Allen RJ. et al. Using the Retrograde Internal Mammary System for Stacked Perforator Flap Breast Reconstruction: 71 Breast Reconstructions in 53 Consecutive Patients. Plast Reconstr Surg 2016; 137: 265e-277e
    CrossrefPubMedSearch in Google Scholar
  • 19 Chu MW, Samra F, Kanchwala SK. et al. Treatment Options for Bilateral Autologous Breast Reconstruction in Patients with Inadequate Donor-Site Volume. J Reconstr Microsurg 2017; 33: 305-311
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Albornoz CR, Bach PB, Mehrara BJ. et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg 2013; 131: 15-23
    CrossrefPubMedSearch in Google Scholar
  • 21 Mayo JL, Allen RJ, Sadeghi A. Four-flap Breast Reconstruction: Bilateral Stacked DIEP and PAP Flaps. Plast Reconstr Surg Glob Open 2015; 3: e383
    CrossrefPubMedSearch in Google Scholar
  • 22 Khouri RK, Rigotti G, Khouri RK. et al. Tissue-engineered breast reconstruction with Brava-assisted fat grafting: a 7-year, 488-patient, multicenter experience. Plast Reconstr Surg 2015; 135: 643-658
    CrossrefPubMedSearch in Google Scholar
  • 23 Kanchwala SK, Glatt BS, Conant EF. et al. Autologous fat grafting to the reconstructed breast: the management of acquired contour deformities. Plast Reconstr Surg 2009; 124: 409-418
    CrossrefPubMedSearch in Google Scholar
  • 24 Slavin SA. Improving the latissimus dorsi myocutaneous flap with tissue expansion. Plast Reconstr Surg 1994; 93: 811-824
    CrossrefPubMedSearch in Google Scholar
  • 25 Biggs TM, Cronin ED. Technical aspects of the latissimus dorsi myocutaneous flap in breast reconstruction. Ann Plast Surg 1981; 6: 381-388
    CrossrefPubMedSearch in Google Scholar
  • 26 Figus A, Mazzocchi M, Dessy LA. et al. Treatment of muscular contraction deformities with botulinum toxin type A after latissimus dorsi flap and sub-pectoral implant breast reconstruction. J Plast Reconstr Aesthet Surg 2009; 62: 869-875
    CrossrefPubMedSearch in Google Scholar
  • 27 Button J, Scott J, Taghizadeh R. et al. Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques. J Plast Reconstr Aesthet Surg 2010; 63: 1505-1512
    CrossrefPubMedSearch in Google Scholar
  • 28 Roehl KR, Baumann DP, Chevray PM. et al. Evaluation of outcomes in breast reconstructions combining lower abdominal free flaps and permanent implants. Plast Reconstr Surg 2010; 126: 349-357
    CrossrefPubMedSearch in Google Scholar
  • 29 Borsen-Koch M, Gunnarsson GL, Udesen A. et al. Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA). J Plast Reconstr Aesthet Surg 2015; 68: 815-821
    CrossrefPubMedSearch in Google Scholar
  • 30 Moran SL, Herceg S, Kurtelawicz K. et al. TRAM flap breast reconstruction with expanders and implants. AORN J 2000; 71: 354-362 quiz 363-358
    CrossrefPubMedSearch in Google Scholar
  • 31 Miller MJ, Rock CS, Robb GL. Aesthetic breast reconstruction using a combination of free transverse rectus abdominis musculocutaneous flaps and breast implants. Ann Plast Surg 1996; 37: 258-264
    CrossrefPubMedSearch in Google Scholar
  • 32 Momeni A, Kanchwala SK. Improved pocket control in immediate microsurgical breast reconstruction with simultaneous implant placement through the use of mesh. Microsurgery 2018; 38: 450-457
    CrossrefPubMedSearch in Google Scholar
  • 33 Gunnarsson GL, Borsen-Koch M, Nielsen HT. et al. Bilateral Breast Reconstruction with Extended Thoracodorsal Artery Perforator Propeller Flaps and Implants. Plast Reconstr Surg Glob Open 2015; 3: e435
    CrossrefPubMedSearch in Google Scholar
  • 34 Kanchwala S, Momeni A. Hybrid breast reconstruction-the best of both worlds. Gland Surg 2019; 8: 82-89
    CrossrefPubMedSearch in Google Scholar
  • 35 Bach AD, Morgenstern IH, Horch RE. Secondary “Hybrid Reconstruction” Concept with Silicone Implants After Autologous Breast Reconstruction – Is It Safe and Reasonable?. Medical science monitor : international medical journal of experimental and clinical research 2020; 26: e921329
    CrossrefPubMedSearch in Google Scholar
  • 36 Walters JA, Sato EA, Martinez CA. et al. Delayed Mammoplasty with Silicone Gel Implants following DIEP Flap Breast Reconstruction. Plast Reconstr Surg Glob Open 2015; 3: e540
    CrossrefPubMedSearch in Google Scholar
  • 37 Pien IJ, Anolik R, Blau J. et al. Delayed implant augmentation of breast free flaps. J Reconstr Microsurg 2015; 31: 254-260
    Thieme ConnectPubMedSearch in Google Scholar
  • 38 Spear SL, Wolfe AJ. The coincidence of TRAM flaps and prostheses in the setting of breast reconstruction. Plast Reconstr Surg 2002; 110: 478-486
    CrossrefPubMedSearch in Google Scholar
  • 39 Momeni A, Kanchwala S. Delayed-immediate hybrid breast reconstruction-Increasing patient input and precision in breast reconstruction. Breast J 2019; 25: 898-902
    CrossrefPubMedSearch in Google Scholar
  • 40 Komorowska-Timek E, Gurtner GC. Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg 2010; 125: 1065-1073
    CrossrefPubMedSearch in Google Scholar
  • 41 Khansa I, Colakoglu S, Curtis MS. et al. Postmastectomy breast reconstruction after previous lumpectomy and radiation therapy: analysis of complications and satisfaction. Ann Plast Surg 2011; 66: 444-451
    CrossrefPubMedSearch in Google Scholar
  • 42 Chang DW, Barnea Y, Robb GL. Effects of an autologous flap combined with an implant for breast reconstruction: an evaluation of 1000 consecutive reconstructions of previously irradiated breasts. Plast Reconstr Surg 2008; 122: 356-362
    CrossrefPubMedSearch in Google Scholar
  • 43 Yun JH, Diaz R, Orman AG. Breast Reconstruction and Radiation Therapy. Cancer Control 2018; 25: 1073274818795489
    CrossrefPubMedSearch in Google Scholar
  • 44 Zhao R, Tran BNN, Doval AF. et al. A Multicenter Analysis Examining Patients Undergoing Conversion of Implant-based Breast Reconstruction to Abdominally based Free Tissue Transfer. J Reconstr Microsurg 2018; 34: 685-691
    Thieme ConnectPubMedSearch in Google Scholar