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Breast Reconstruction: The Current Environment and Future Directions
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Breast Reconstruction: The Current Environment and Future Directions

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: closed (30 May 2025) | Viewed by 2615

Special Issue Editor

Dr. Chris A. Campbell

E-Mail Website
Guest Editor
Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA
Interests: breast reconstruction; plastic surgery; microsurgery; trunk and extremity reconstruction; cancer resection; head and neck reconstruction

Special Issue Information

Dear Colleagues,

The field of breast reconstruction is constantly evolving, aiming to enhance patient experience and achieve optimal results. In today's healthcare landscape, informed patients are seeking the best clinical outcomes, leading to a growing demand for breast reconstruction procedures. Regulatory scrutiny of implantable devices used in these procedures places a significant responsibility on plastic surgeons to gather and assess data rigorously, ensuring high-quality care and continued access to advanced resources. Plastic surgeons are dedicated to improving patient access to breast reconstruction by streamlining processes, managing costs efficiently and prioritizing patient satisfaction.

This issue focuses on the changing landscape of plastic and reconstructive surgery.

Dr. Chris A. Campbell
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 100 words) can be sent to the Editorial Office for announcement on this website.

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
  • plastic surgery
  • microsurgery
  • trunk and extremity reconstruction
  • cancer resection
  • head and neck reconstruction

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Published Papers (4 papers)

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Research

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10 pages, 1106 KiB  
Article
Comparison of Surgical Outcomes in Robot-Assisted Nipple Sparing Mastectomy with Conventional Open Nipple Sparing Mastectomy: A Single Center Experience
by Ji Young You, Young Min Kim, Eun-shin Lee, Haemin Lee and Seung Pil Jung
J. Clin. Med. 2025, 14(13), 4608; https://doi.org/10.3390/jcm14134608 - 29 Jun 2025
Viewed by 387
Abstract
Background: A surgical therapy for breast cancer, robot-assisted nipple-sparing mastectomy (RANSM) has gained popularity because it may offer better cosmetic results than traditional nipple-sparing mastectomy (CNSM). Data regarding RANSM’s viability and security are still scarce, nevertheless. Comparing the surgical results of RANSM [...] Read more.
Background: A surgical therapy for breast cancer, robot-assisted nipple-sparing mastectomy (RANSM) has gained popularity because it may offer better cosmetic results than traditional nipple-sparing mastectomy (CNSM). Data regarding RANSM’s viability and security are still scarce, nevertheless. Comparing the surgical results of RANSM and CNSM in a single-center experience was the goal of this study. Methods: 57 patients who had nipple-sparing mastectomy procedures performed at our facility between January and December 2021 were included in this retrospective research. Of them, 49 patients had CNSM, and 8 patients had RANSM. Analysis was performed on pain scores, length of hospital stay, postoperative complications, patient demographics, and operating time. Results: The mean total operative time was longer for RANSM group was 148 min compared to 117 min for the CNSM group; however, this difference was not statistically significant (p = 0.083). The mean duration of hospital stay was shorter for the RANSM group than for the CNSM group (10.75 days vs. 2.92 days, respectively; p = 0.302). Both groups had similar pain scores on postoperative day 3 (RANSM: 3.50, CNSM: 3.54, p = 0.926). No patient in the RANSM group received adjuvant chemotherapy or radiotherapy, whereas 32.6% of patients in the CNSM group received chemotherapy. The RANSM and CNSM groups experienced complications at rates of 12.5% and 18.4%, respectively (p = 0.571). In contrast to 14.3% in the CNSM group, there were no documented incidences of skin necrosis in the RANSM group. Conclusions: RANSM demonstrated comparable safety to CNSM with potential benefits, including a shorter hospital stay and lower complication rates. These findings support the feasibility of RANSM, particularly in patients prioritizing cosmetic outcomes. To validate these initial findings, more research with larger cohorts and longer follow-up times is necessary. Full article
(This article belongs to the Special Issue Breast Reconstruction: The Current Environment and Future Directions)
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13 pages, 3307 KiB  
Article
Preclinical Volume Retention of Fat Grafts Processed with REVOLVE™ Technology or Decantation Methods in Irradiated and Nonirradiated Wounds
by Christopher A. Campbell, Graham M. Grogan, Samantha St. Jean, Nimesh Kabaria, Maryellen Gardocki-Sandor and Patrick S. Cottler
J. Clin. Med. 2025, 14(9), 3100; https://doi.org/10.3390/jcm14093100 - 30 Apr 2025
Viewed by 388
Abstract
Background: The processing of harvested fat for transplantation is critical to fat graft performance. In breast reconstruction, larger volumes of fat are being grafted and, in some clinical cases, are being implanted within radiated tissue. This preclinical animal study evaluated the effects of [...] Read more.
Background: The processing of harvested fat for transplantation is critical to fat graft performance. In breast reconstruction, larger volumes of fat are being grafted and, in some clinical cases, are being implanted within radiated tissue. This preclinical animal study evaluated the effects of radiation on retention volume and fat graft quality after processing by decantation or REVOLVE™ technology (Allergan Aesthetics, an AbbVie Company), a filtration-based device that can process lipoaspirates and remove unwanted contaminants prior to grafting. Methods: Lipoaspirate was collected from human donors (n = 6), processed using either REVOLVE™ technology or decantation, and implanted (0.5 cc) into 60 athymic mice for 4 weeks with or without a single 35-Gy radiation dose 12 weeks prior. Volume composition, MRI, and weight-based volumetric assessment of grafted fat were performed and compared between radiated and non-radiated mice. Results: Volume composition analysis demonstrated significantly higher fat content and lower aqueous fluid with REVOLVE™ technology than with decantation, with minimal cellular debris and free oil. MRI-based and weight-based volume analysis demonstrated a significantly higher percent retention with REVOLVE™ technology than decantation in nonirradiated and irradiated sites, respectively. Pathology scoring showed a significant decrease in fibrosis within grafts processed with REVOLVE™ technology in nonirradiated sites. Conclusions: Results suggest that fat processed using REVOLVE™ technology provides better early volume retention and quality of fat grafts compared to decantation, both in healthy and radiation-treated surgical sites. Full article
(This article belongs to the Special Issue Breast Reconstruction: The Current Environment and Future Directions)
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11 pages, 14092 KiB  
Article
Prevalence of Breast Cancer-Related Lymphedema in Israeli Women Following Axillary Procedures
by Daniel Josef Kedar, Elad Zvi, Oriana Haran, Lior Sherker, Michael Sernitski, Nadav Oppenheim, Eran Nizri, Marian Khatib and Yoav Barnea
J. Clin. Med. 2025, 14(3), 688; https://doi.org/10.3390/jcm14030688 - 22 Jan 2025
Viewed by 1022
Abstract
Background/Objectives: Breast cancer-related lymphedema (BCRL) is a chronic complication of breast cancer treatment, leading to physical and psychological morbidity. While widely studied globally, the prevalence and risk factors for BCRL in Israeli patients remain unexplored. This study’s objectives were to determine the prevalence [...] Read more.
Background/Objectives: Breast cancer-related lymphedema (BCRL) is a chronic complication of breast cancer treatment, leading to physical and psychological morbidity. While widely studied globally, the prevalence and risk factors for BCRL in Israeli patients remain unexplored. This study’s objectives were to determine the prevalence of BCRL in Israeli women treated for breast cancer, validate the Hebrew-translated Norman Questionnaire (NQ) for BCRL screening, and identify risk factors associated with the condition. Methods: A single-center study was conducted at Tel Aviv Sourasky Medical Center, including 181 patients who underwent unilateral axillary lymph node interventions between 2015 and 2018. Participants completed the Hebrew-translated NQ, which was validated through clinical evaluation and circumference-based volume measurements in a subset of 20 patients. Prevalence rates and risk factors were analyzed using multivariate modeling. Results: The prevalence of BCRL was 20%, with rates varying by procedure: 8.9% for sentinel lymph node biopsy, 19.6% for lymph node sampling, and 37.5% for axillary lymph node dissection (ALND). Of the 35 patients with BCRL, only 14% had been previously diagnosed. Risk factors included ALND (OR = 97.31), a higher lymph node excision count (OR = 0.81), and referral to physiotherapy (OR = 133.50). The Hebrew NQ demonstrated strong validity (rs = 0.852; p < 0.001). Conclusions: This is the first study to estimate BCRL prevalence in Israeli women, highlighting underdiagnosis and the need for improved early detection. The Hebrew NQ is a reliable screening tool, enabling timely referral and intervention. Early diagnosis is crucial for optimizing treatment outcomes and improving the quality of life of BCRL patients. Full article
(This article belongs to the Special Issue Breast Reconstruction: The Current Environment and Future Directions)
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Review

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12 pages, 235 KiB  
Review
The Role of Exclusive Autologous Lipotransfer in Non-Irradiated Breasts After Mastectomy
by Aikaterini-Gavriela Giannakaki, Eftychia Papachatzopoulou, Ioannis Papapanagiotou, Sophia Koura, Dimitris Baroutis, Spyridon Marinopoulos, George Daskalakis and Constantine Dimitrakakis
J. Clin. Med. 2025, 14(13), 4468; https://doi.org/10.3390/jcm14134468 - 24 Jun 2025
Viewed by 358
Abstract
Background/Objectives: Autologous fat grafting (AFT) has become a widely used technique in breast reconstruction, offering natural aesthetics, tissue integration, and patient satisfaction. However, its clinical outcomes require comparison with implant-based reconstruction (IBR), the most common method in clinical practice. While AFT provides a [...] Read more.
Background/Objectives: Autologous fat grafting (AFT) has become a widely used technique in breast reconstruction, offering natural aesthetics, tissue integration, and patient satisfaction. However, its clinical outcomes require comparison with implant-based reconstruction (IBR), the most common method in clinical practice. While AFT provides a more natural appearance and avoids foreign body-related complications, issues such as fat resorption, procedural variability, and oncological concerns necessitate further investigation. Additionally, artificial intelligence (AI) has been increasingly integrated into breast imaging and reconstructive planning, improving diagnostic accuracy, procedural optimization, and complication prevention. This study aims to compare AFT and IBR while exploring AI’s role in enhancing breast reconstruction outcomes. Methods: A comprehensive review of clinical studies was conducted to evaluate the advantages, limitations, and oncological implications of AFT versus IBR. AI-driven applications in breast imaging and reconstructive planning were examined for their potential in predicting fat graft retention and optimizing implant selection. Data from systematic reviews and meta-analyses were incorporated to refine reconstruction strategies. Results: AFT offers superior aesthetic outcomes with better tissue integration but presents variability in fat resorption. IBR remains the preferred approach due to its predictability but carries risks of implant-related complications. AI technologies contribute to improved reconstruction planning, enhancing surgical precision and long-term patient outcomes. Conclusions: Optimized patient selection and long-term follow-up are essential for improving breast reconstruction techniques. AI-driven approaches provide valuable tools for enhancing procedural predictability and personalized treatment strategies. Future research should focus on refining AI algorithms and establishing standardized protocols for reconstructive decision-making. Full article
(This article belongs to the Special Issue Breast Reconstruction: The Current Environment and Future Directions)
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