Wow.
I just got done with the Aesthetic Plastic Surgical Meeting 2020 (@home, thank you quarantine!). It was great. I will be doing more blogs on this, as I really thought the results the presenters showed were fantastic.
There seems to be a new gold standard for breast cancer reconstruction. It looks to give more natural results, debunks a lot of things we have traditionally thought as basic facts, and can be done in one surgery.
Nipple Sparing. This seems to be the norm for any surgery which can be done this way. Not new, but seems to be the more standard technique now.
Large incision at the inframammary fold. This is not surprising, as prior studies have shown with nipple sparing surgery that this incision is much better for the nipple.
UNLESS you need a lift, so you use a vertical scar or do a separate reduction/lift surgery prior to the mastectomy. A small lift can usually be done by doing a small repositioning and having the incision being a vertical scar only. If you are doing elective mastectomy (read: BRCA gene), and you need a lift, they like to do a breast reduction or breast lift 3- 6 months before the nipple sparing mastectomy to position the nipple better and decrease the risk of nipple issues when doing the mastectomy.
Prepectoral position of the implant. This was a doozy for me to see. We have traditionally not done this because of visible rippling, wrinkling, implant edges, risk of implant exposure, capsular contracture, and other issues. What they showed was when covered with ADM, and with a general surgeon who doesn’t leave uneven or too thin of flaps, you can get great results, even without using fat grafting to smooth it out.
Use of ADM. In everyone. There was some discussion between traditional ADM like Alloderm, vs. Galaflex. I will need to research this more.
Smooth implants. After the ALCL scare with textured implants, this didn’t surprise me much. Though the shape and longevity of the results were great. I think that is mostly from the ADM coverage and prepectoral position.
Single stage reconstruction. Immediate to implant. They often will scan the blood supply of the flaps in surgery to confirm good blood supply. But they prefer this technique, particularly if radiation is needed. Much better to have the reconstruction done prior to radiation.
So do these reconstructive surgeons all do their breast augs in front of the muscle too? The answer to this was no- most still favor behind the muscle augmentation. Next blog will discuss why.
So what do I think?
Many of these things are not so new. But the focus on single state reconstruction and prepectoral positioning of implants is. The use of intraoperative studies to check on the vascularity of the mastectomy flaps by the general surgeon has gained traction.
And this just emphasizes what I love about my profession. I love being a plastic surgeon. I love that what I do today is different than what I did 5 years ago. I love that we are using science and studying what we do to continually improve our techniques. One of the surgeons is using grafts to try to reinnervate nipples, which were spared for mastectomy but traditionally lose sensation during the process.
And I loved that the surgeons showed complications and discussed limitations of the new procedures and what needs to be studied and improved on.