Breast Reconstruction, An Actual Review

Breast cancer treatment involves a multidisciplinary approach, including oncologic surgery, adjuvant therapy, and psychosocial therapies. Breast reconstruction has evolved over time, with early beliefs preventing its use. Early techniques included autologous breast reconstruction, local myocutaneous flaps, tubed pedicle flaps, prosthetic implant-based reconstructions, and silicone implants. Modern procedures began with the free flap in 1973, which allowed for more precise matching of normal breast tissue. Advancements in abdominal-based free flaps, transverse rectus abdominis myocutaneous (TRAM) flaps, and the DIEP flap have contributed to its popularity. Advancements in breast reconstructive surgery have been significantly influenced by advancements in microsurgery, including the discovery of the free flap and the development of perforator-based flaps. The introduction of preoperative imaging methods, such as computed tomography angiography (CT), has made breast reconstruction more efficient. The use of operating microscopes and microvascular anastomotic coupler devices has also improved surgical procedures. However, flap perfusion remains a challenge, and new approaches like fluorescence imaging and laser Doppler imaging can help diagnose flap impairment. Despite the early stages of breast surgery research, advances in pre-operative planning and imaging remain significant. The combination of virtual reality and robotic surgery could further enhance the capabilities of doctors in breast reconstruction.