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Innovations in Microsurgical Techniques for Breast Cancer Reconstruction

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 3439

Special Issue Editors


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Guest Editor
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
Interests: autologous breast reconstruction; lymphedema; patient-reported outcomes
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
Interests: alternative flaps; DIEP flap; autologous breast reconstruction; PAP flaps; LAP flaps

Special Issue Information

Dear Colleagues,

Breast cancer is the leading cancer in women, affecting close to 30% of women in their lifetime. Surgical management of breast cancer is highly effective but can result in scars, cosmetic deformities, or an absence of breast. Not surprisingly, these consequences can greatly affect the psychosocial well-being of women. Breast reconstruction aims to address these effects and has been shown to improve patient outcomes and quality of life following ablative surgery for breast cancer. The options include oncoplastic techniques, implant-based reconstructions, autologous reconstruction, or a combination of the above.

While the choice of reconstructive type is a personal one, autologous reconstruction has been shown to provide a more natural reconstruction that lasts forever and is associated with higher patient satisfaction and a lower cost than implants. Because of this, there has been an increasing focus on autologous breast reconstruction over the past several decades. Advances in technology as well as our understanding of anatomy and blood supply have concurrently improved our outcomes and limited the morbidity associated with breast reconstruction. It is to these innovations and ones that are currently being explored/developed that we have dedicated this Special Issue on “Innovations in Microsurgical Techniques for Breast Cancer Reconstruction”. Our focus will be on showing the evolution of microsurgical breast reconstruction through innovation to its current state of the art. We hope to show the transition from working towards a successful reconstruction to one that is also esthetically pleasing, sensate, and functionally conscious.

Dr. Babak J. Mehrara
Dr. Robert J. Allen
Guest Editors

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Keywords

  • breast reconstruction
  • autologous breast reconstruction
  • DIEP flap
  • robotic DIEP flap
  • sensibility
  • alternative flaps
  • post-mastectomy pain
  • PAP flap
  • LAP flap
  • GAP flap
  • LTP flap
  • perforator flap
  • latissimus flap
  • fat grafting
  • nerve repair

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Published Papers (3 papers)

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Research

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11 pages, 1150 KB  
Article
Characterizing Trends of Lymphedema After Axillary Lymph Node Dissection with and Without Immediate Lymphatic Reconstruction
by Kella L. Vangsness, Andre-Philippe Sam, Jeff Chang, Yash A. Mehta, Michael W. Chu, Mouchammed Agko and Antoine L. Carré
Cancers 2025, 17(18), 2964; https://doi.org/10.3390/cancers17182964 - 10 Sep 2025
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Abstract
Background and Objectives: Breast cancer-related lymphedema (BCRL) is a complication of axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) may help to decrease lymphedema after ALND by creating lymphatic bypasses. This retrospective single-institution study aimed to compare lymphedema in patients undergoing ALND [...] Read more.
Background and Objectives: Breast cancer-related lymphedema (BCRL) is a complication of axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) may help to decrease lymphedema after ALND by creating lymphatic bypasses. This retrospective single-institution study aimed to compare lymphedema in patients undergoing ALND with and without ILR. Materials and Methods: Bioimpedance and limb measurements determined the presence of BCRL. The categorical data that were collected and analyzed included BMI, comorbidities, BCRL onset, and number of lymphatic bypasses. Pearson’s chi-square test and multivariable logistic regression were performed to identify factors associated with the onset of lymphedema. An odds ratio compared the incidence of BCRL with and without ILR. Results: In total, 186 patients underwent ALND, 44 (24%) with ILR and 142 (76%) without. The mean number of bypasses during ILRs created was 3.54. The odds of developing lymphedema with ILR were 64% lower than for ALND alone. ILR patients who developed BCRL had a mean onset of 543 days post-operatively versus 389 days in the control group. Age, ethnicity, BMI, and bypass amount had no significant influence on lymphedema development. Conclusions: ILR was associated with lower rates of BCRL after ALND. Patients who developed lymphedema despite undergoing ILR did so 8 months later than the controls. Full article
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Review

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14 pages, 1428 KB  
Review
Microsurgical Strategies in Post-Radiation and Revision Breast Reconstruction: Optimizing Outcomes in High-Risk Patients
by Thomas J. Sorenson, Carter J. Boyd, Oriana Cohen, Mihye Choi and Nolan Karp
Cancers 2025, 17(23), 3831; https://doi.org/10.3390/cancers17233831 - 29 Nov 2025
Viewed by 653
Abstract
Patients requiring breast reconstruction following radiation therapy or prior failed autologous breast reconstruction (ABR) or implant-based breast reconstruction (IBBR) represent a challenging cohort and often present with compromised vascularity, scarred anatomy, and subsequent increased rates of complications. In this review, we discuss microsurgical [...] Read more.
Patients requiring breast reconstruction following radiation therapy or prior failed autologous breast reconstruction (ABR) or implant-based breast reconstruction (IBBR) represent a challenging cohort and often present with compromised vascularity, scarred anatomy, and subsequent increased rates of complications. In this review, we discuss microsurgical strategies designed to optimize donor tissue in these challenging clinical scenarios, including the use of stacked or bipedicled flaps, and the utility of intraoperative indocyanine green angiography. We also review approaches to alternate recipient vessel selection in the suboptimal chest, and we address specific strategies for the revision setting, like soft tissue support and hybrid reconstruction with ABR and IBBR. By synthesizing the current literature and expert experience, this narrative review provides a practical framework for microsurgeons managing complex breast reconstruction in higher-risk patients. Full article
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17 pages, 524 KB  
Review
Redefining Reconstruction: Technological Innovations in Microsurgical Breast Reconstruction
by Nicole E. Speck and Jian Farhadi
Cancers 2025, 17(23), 3739; https://doi.org/10.3390/cancers17233739 - 22 Nov 2025
Viewed by 681
Abstract
Background: Microsurgical breast reconstruction is advancing rapidly with the integration of innovative technologies that enhance surgical precision, safety, and outcomes. This narrative review highlights recent developments across four key phases: flap planning, flap harvest, microvascular anastomosis, and flap monitoring. Methods: To [...] Read more.
Background: Microsurgical breast reconstruction is advancing rapidly with the integration of innovative technologies that enhance surgical precision, safety, and outcomes. This narrative review highlights recent developments across four key phases: flap planning, flap harvest, microvascular anastomosis, and flap monitoring. Methods: To identify the most updated and relevant data, all content on «Aesthetic and Reconstructive Breast Surgery Network» (ARBS Network, Copyright 2025 Mark Allen Group, United Kingdom) was screened regarding new technology. The contributions were grouped into one of four key phases. More references related to the content viewed were then searched on the electronic database MEDLINE (Bethesda, MD: U.S. National Library of Medicine). Results: 24 contributions regarding new technology were identified on ARBS Network. Of these, 17 were relevant for this paper. Preoperative tools such as CT angiography and AI-based perforator mapping optimize surgical planning and execution. Robotic-assisted or endoscopic techniques for deep inferior epigastric perforator (DIEP) flap harvest enable minimally invasive dissection with reduced donor-site morbidity and improved muscle preservation. Robotic microsurgery, particularly with the MUSA and Symani® Surgical System, allows for precise, tremor-free suturing of submillimeter vessels. Indocyanine green (ICG) angiography remains the gold standard for intraoperative perfusion evaluation. Postoperative flap surveillance is crucial for detecting vascular compromise early. Devices such as the Cook-Swartz Doppler probe and flow couplers offer continuous monitoring. Wireless oximetry systems like ViOptix® provide non-invasive, real-time perfusion data and support remote monitoring. Conclusions: Collectively, these innovations are transforming microsurgical breast reconstruction by increasing efficiency, consistency, and outcomes. Full article
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