Chapter 1 Although breast reconstruction with implants has improved, there remain implant‐ related complications, such as infection, capsular contracture, implant rotation, and implant displacement.32,33 In addition, implant breast reconstruction still feels less natural compared with autologous breast reconstruction. In case radiation of the chest wall is indicated, secondary autologous reconstruction is recommended. Therefore, many consider, either by personal choice or for clinical reasons, autologous breast reconstruction the golden standard for breast reconstruction. Autologous breast reconstruction The longevity of results obtained with autologous breast reconstruction is superior compared with implant‐based reconstruction. In direct reconstruction, complete breast mound restoration in a single‐stage with skin‐sparing mastectomy is possible in most cases. Autologous breast reconstruction compared with implant has better size and shaping possibilities, which may permit matching the contralateral breast without contralateral surgery. The first documented autologous breast reconstruction was reported in two case reports in the late 19th century. In Table 1.1, the evolution of various options of autologous breast reconstruction is summarized. Table 1.1 Evolution of autologous breast reconstruction to the DIEP flap. 1887 Pedicled contralateral breast (Veneuil34) 1895 Free lipoma transplantation (Czerny35) 1912 Pedicled latissimus dorsi myocutaneous flap (Tansini36) 1950 Composite tubed pedicled contralateral breast (Yannilos37) 1963 Pedicled greater omentum flap (Kiricuta38) 1975 Free superior gluteal artery myocutaneous flap (Fujino39) 1979 Pedicled vertical rectus abdominis myocutaneous flap (Robbins40) 1979 Free TRAM flap (Holmstrom41) 1982 Pedicled transverse rectus abdominis flap (Hartrampf et al.42) 1989 Free inferior gluteal artery myocutaneous flap (Poletta et al.43) 1994 Free DIEP flap (Allen et al.44) DIEP, deep inferior epigastric perforator; TRAM, transverse rectus abdominis myocutaneous. The work by Taylor et al. with their landmark study describing the vascular anatomy of the integument system in 1987 revolutionized reconstructive surgery. The angiosome concept in which a three‐dimensional composite unit of tissue is discerned that is supplied by a single source artery was introduced.45 Concurrently, in the 1960s and 1970s, microsurgical techniques found their way from laboratory to clinical applications. In the following three decades (1970s–1990s), tremendous progress in free flap surgery has taken place. Numerous flaps were identified, and most are still being used today.46 In the hands of experienced reconstructive surgeons free flap breast recon‐structive procedures are in 95 to 99% succesful nowadays. 14
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