Symmetrization in Breast Reconstruction: Augmentation Procedures

Skin-sparing and nipple-sparing mastectomies combined with immediate reconstruction and refinements in reconstructive techniques have shifted patients’ expectations of breast cancer management from surviving breast cancer to achieving aesthetically pleasing results. The primary aim of any breast reconstruction technique is to create natural-appearing breasts with maximum symmetry. Mastectomy and breast-conserving surgery (BCS) are two main surgical options for ablation of the affected breast. Several factors play a role in the decision making such as tumor size to breast ratio, indication for radiation, location and centricity of the lesion, and the patient’s motivation for a contralateral procedure. Post-oncological breast reconstruction is basicly conducted in two steps: replacement or restoration of volume and refinement of the breast sub-units. The reconstructive plan is mostly dictated by the oncological treatment plan. The choice of reconstruction depends on several different factors including the patient’s body habitus, need for adjuvant radiotherapy, and the patient’s personal preferences. Autologous tissue or implants can be used for primary augmentation of the effected breast, and lipofilling is a valuable instrument for secondary revisions. Delayed augmentation procedures may be more advantageous for contralateral breasts in achieving symmetry after adjuvant therapies are completed.