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New Clinical Advances in Breast Reconstruction
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New Clinical Advances in Breast Reconstruction

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: 20 June 2026 | Viewed by 2774

Special Issue Editor

Prof. Dr. Nobuyuki Mitsukawa

E-Mail Website
Guest Editor
Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
Interests: reconstructive surgery of the whole body; head and neck; breast; limbs with lymphatic disorders; aesthetic surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Breast reconstruction is a crucial aspect of post-mastectomy care, significantly improving patients’ quality of life. In recent decades, advancements in microsurgery, implant technology, and autologous tissue reconstruction have expanded options for patients. Despite these innovations, challenges remain, such as optimizing reconstruction for radiotherapy patients, reducing complications, and improving aesthetic and functional outcomes.

This Special Issue aims to highlight cutting-edge research addressing key issues in breast reconstruction, including long-term implant safety, flap viability, fat grafting techniques, endoscopic surgery, robotic surgery, and patient-reported outcomes. We seek to explore solutions for minimizing complications, enhancing surgical precision, and personalizing treatment plans.

We welcome the submission of original research, clinical studies, and reviews covering surgical innovations, patient-centered outcomes, and novel reconstructive techniques. Papers addressing postoperative care, complication management, and emerging technologies are also encouraged.

Plastic surgeons, oncologists, and researchers are invited to contribute their latest findings. High-quality submissions will undergo peer review, ensuring impactful contributions to the field. By participating in this Special Issue, authors will help shape the future of breast reconstruction and improve patient care worldwide.

Prof. Dr. Nobuyuki Mitsukawa
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • breast reconstruction
  • autologous (flap) reconstruction
  • implant-based reconstruction
  • microsurgery and perforator flaps
  • robotic surgery/endoscopic surgery
  • fat grafting (lipofilling)
  • patient-reported outcomes
  • reconstructive surgical innovation

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Published Papers (4 papers)

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Research

12 pages, 3699 KB  
Article
Photoacoustic Imaging of Vascular Structure After Breast Reconstruction with Autologous Fat Grafting: A Pilot Study
by Yui Tsunoda, Mayu Muto, Minami Noto and Toshihiko Satake
J. Clin. Med. 2026, 15(3), 1272; https://doi.org/10.3390/jcm15031272 - 5 Feb 2026
Viewed by 476
Abstract
Background/Objectives: Autologous fat grafting (AFG) is widely used in breast reconstruction; however, graft retention remains unpredictable due to recipient-bed variability. Photoacoustic imaging (PAI) is a contrast-free, noninvasive modality enabling visualization of vascular structures in detail. This study used PAI to visualize and quantitatively [...] Read more.
Background/Objectives: Autologous fat grafting (AFG) is widely used in breast reconstruction; however, graft retention remains unpredictable due to recipient-bed variability. Photoacoustic imaging (PAI) is a contrast-free, noninvasive modality enabling visualization of vascular structures in detail. This study used PAI to visualize and quantitatively assess neovascularization and vascular structure in breasts reconstructed with AFG. Methods: In this retrospective, cross-sectional study, data from eight patients who underwent PAI of both reconstructed and contralateral breasts at least three months after their final AFG procedure for total breast reconstruction were used. Excluding the nipple–areola complex and skin markings, four 3 × 3 cm regions of interest (one per quadrant) were selected in the periareolar region. Vascular density in terms of depth from the skin surface was analyzed in five cases with adequate contact between the device and the skin. Visible vessel diameters within the regions of interest were manually measured and categorized as small, medium, or large to assess distribution patterns. Results: PAI successfully enabled visualization of vascular structures on the reconstructed side in all cases, even at depths greater than 10 mm. In five cases, vascular density in the superficial layer (0–2.5 mm) was higher on the reconstructed side than on the contralateral side. A longer postoperative interval was associated with a higher proportion of small vessels and fewer large vessels. Conclusions: PAI enabled noninvasive visualization of vascular structures consistent with neovascularization on the reconstructed side after AFG. Temporal changes in vessel diameter distribution suggest ongoing vascular remodeling, supporting the potential utility of PAI in assessing vascular structural changes in grafted tissue over time. Full article
(This article belongs to the Special Issue New Clinical Advances in Breast Reconstruction)
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10 pages, 1406 KB  
Article
Breast Reconstruction Using the Axillary-Approach Endoscopic Extended Latissimus Dorsi (Ax-eeLD) Flap
by Shinsuke Akita, Yoshihisa Yamaji, Haruka Maei, Kahoko Yamada, Nobuhiro Ando, Kentaro Kosaka, Hiroshi Fujimoto and Nobuyuki Mitsukawa
J. Clin. Med. 2026, 15(2), 703; https://doi.org/10.3390/jcm15020703 - 15 Jan 2026
Viewed by 447
Abstract
Background/Objectives: Although the endoscopic extended latissimus dorsi (eeLD) flap avoids dorsal scarring, a lateral thoracic incision is still required. We developed an axillary-approach endoscopic extended latissimus dorsi (Ax-eeLD) flap enabling harvest through a single 40-mm axillary incision and two 5-mm ports. This [...] Read more.
Background/Objectives: Although the endoscopic extended latissimus dorsi (eeLD) flap avoids dorsal scarring, a lateral thoracic incision is still required. We developed an axillary-approach endoscopic extended latissimus dorsi (Ax-eeLD) flap enabling harvest through a single 40-mm axillary incision and two 5-mm ports. This study evaluated its safety and feasibility and compared outcomes with conventional eeLD. Methods: Patients who underwent Ax-eeLD flap (study group) were retrospectively analyzed and compared with the patients who underwent conventional eeLD flap (control group, n = 15). The flap was elevated endoscopically via a single 40-mm axillary incision and two 5-mm ports, harvesting the entire latissimus dorsi muscle with its surrounding adipose tissue. Outcomes included incision length, operative time, complications, secondary fat grafting, and BREAST-Q scores. Results: Fifteen patients (post-mastectomy, n = 13; congenital hypoplasia, n = 2) underwent Ax-eeLD flap. All procedures used only the planned incisions without intraoperative complications. The study group had significantly shorter incisions than the control group (39 ± 1 mm vs. 89 ± 9 mm, p < 0.01). Operative times were similar between the groups. Eight patients developed seromas, all of which were resolved by outpatient aspiration. The frequency of postoperative cases requiring fat grafting did not differ significantly between the study and control groups (4 vs. 8; p = 0.26). BREAST-Q scores improved postoperatively and were similar between groups. Conclusions: Ax-eeLD flap enables minimally invasive harvest of the latissimus dorsi without lateral thoracic scarring. This retrospective case series supports technical feasibility and safety; further prospective studies with objective volume assessment are required. Full article
(This article belongs to the Special Issue New Clinical Advances in Breast Reconstruction)
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9 pages, 432 KB  
Article
Usefulness of the Nipple Delay Procedure in Nipple-Sparing Mastectomy
by Koshi Matsui, Emi Kanaya, Shiho Nagasawa, Misato Araki, Shinichi Sekine, Mutsuki Furukawa, Ameri Urasaki, Toshihiko Satake and Tsutomu Fujii
J. Clin. Med. 2026, 15(2), 426; https://doi.org/10.3390/jcm15020426 - 6 Jan 2026
Viewed by 493
Abstract
Background/Objectives: Nipple-sparing mastectomy (NSM) is a surgical procedure that significantly improves postoperative cosmetic outcomes and quality of life (QOL) while ensuring oncological safety. However, ischemic necrosis of the nipple–areolar complex (NAC), resulting from impaired blood flow, remains a serious complication, particularly in [...] Read more.
Background/Objectives: Nipple-sparing mastectomy (NSM) is a surgical procedure that significantly improves postoperative cosmetic outcomes and quality of life (QOL) while ensuring oncological safety. However, ischemic necrosis of the nipple–areolar complex (NAC), resulting from impaired blood flow, remains a serious complication, particularly in patients with risk factors. To mitigate this ischemic risk, the Nipple Delay (ND) procedure, which applies the principle of surgical delay, has been proposed. The objective of this study was to retrospectively review cases in which the ND procedure was performed prior to NSM with immediate autologous breast reconstruction and to evaluate the safety and clinical utility of this technique in preventing NAC necrosis. Methods: This study included 30 breasts from 30 patients who underwent the ND procedure prior to NSM with autologous reconstruction at our institution. ND was performed under local anesthesia two weeks before NSM. The skin around the NAC was dissected from the underlying breast tissue. Results: The median age of the patients was 49 years, and the mean BMI was 22.7 kg/m2. Risk factors for NAC necrosis included periareolar incision in 24 patients (80.0%), a BMI of 25 kg/m2 or higher in 7 patients (23.3%), and a history of smoking in 8 patients (26.7%). No cases of full-thickness necrosis requiring NAC excision were observed (0%). Partial-thickness necrosis, which healed with conservative treatment, was observed in 6 patients (20.0%). No malignant involvement was detected in subareolar specimens. Conclusions: A staged approach using the ND procedure before NSM suggests effectiveness for preventing serious ischemic complications and safely expanding the indications for NSM, even in patients at high risk of NAC necrosis. Full article
(This article belongs to the Special Issue New Clinical Advances in Breast Reconstruction)
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12 pages, 613 KB  
Article
Primary Prevention Through Prophylactic Mastectomy and Breast Reconstruction: An Exploratory Study on Patient Satisfaction and Quality of Life
by Delia Nicoara, Ioan Constantin Pop, Maximilian Vlad Muntean, Radu Alexandru Ilies and Patriciu Andrei Achimas-Cadariu
J. Clin. Med. 2025, 14(22), 8093; https://doi.org/10.3390/jcm14228093 - 15 Nov 2025
Viewed by 758
Abstract
Background/Objectives: Women who have genetic predisposition to breast cancer often opt for risk-reducing mastectomy with immediate reconstruction. Evaluating their satisfaction and quality of life is essential for guiding shared decision-making. Methods: This exploratory study assessed quality-of-life outcomes in two cohorts of [...] Read more.
Background/Objectives: Women who have genetic predisposition to breast cancer often opt for risk-reducing mastectomy with immediate reconstruction. Evaluating their satisfaction and quality of life is essential for guiding shared decision-making. Methods: This exploratory study assessed quality-of-life outcomes in two cohorts of patients undergoing bilateral prophylactic nipple-sparing mastectomy with immediate prepectoral implant-based reconstruction. Only patients without postoperative complications (necrosis, infection) were included. Each patient completed the BREAST-Q questionnaire both preoperatively (1–2 days before surgery) and postoperatively. Results: Postoperative BREAST-Q scores demonstrated significant improvement, with self-confidence increasing from 40.75 to 44.33, satisfaction with breast size and appearance from 50.42 to 58.50, and general esthetic/functional satisfaction from 26.92 to 33.17 (all p < 0.01). In contrast, physical comfort decreased from 48.00 to 32.42 (p < 0.001). Preoperative responses may have been influenced by anticipatory stress related to the imminent surgery and concern regarding the breast area to be operated. In contrast, postoperative results reflect psychological relief and satisfaction following a successful surgery, with no complications. Conclusions: Nipple-sparing mastectomy with immediate prepectoral reconstruction is associated with high patient-reported satisfaction and perceived improvements in quality of life, particularly regarding body image and emotional well-being. However, functional limitations such as reduced physical comfort should also be acknowledged. These findings further support evidence-based recommendations for prophylactic surgery in high-risk patients. Full article
(This article belongs to the Special Issue New Clinical Advances in Breast Reconstruction)
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