EVALUATION OF BREAST RECONSTRUCTION OPTIONS: IMPLANTS, AUTOLOGOUS FLAPS, AND THE USE OF ACELLULAR DERMAL MATRIX

• DOI: https://doi.org/10.22533/at.ed.159572521012

• Palavras-chave: "Breast Implant", "Autologous Reconstruction", "Aesthetic Outcomes", "Functional Impact", "Recovery Time", "Complications", and "Satisfaction"

• Keywords: "Breast Implant", "Autologous Reconstruction", "Aesthetic Outcomes", "Functional Impact", "Recovery Time", "Complications", and "Satisfaction"

• Abstract:

  INTRODUCTION: Post-mastectomy breast reconstruction is essential for restoring self-esteem and female identity, and actively contributes to patients' physical and emotional rehabilitation. Two techniques are advocated for its implementation: prostheses or autologous tissues. Both methods are widely used, but there are differences between them that can influence the choice of which one to use. OBJECTIVES: This study aims to analyze the different breast reconstruction techniques in order to help patients decide whether to use implants (IBR) or autologous flaps (AR). The aim is to assess the possible impact of radiotherapy, which may indicate a better chronological order between the placement of IBRs and therapy, since exposure to radiation can affect breast tissue to varying degrees, which could end up hindering reconstruction results. The use of acellular dermal matrix (ADM) is also a point to be evaluated in this article, given its potential to improve healing and facilitate implant placement. METHODS: Thus, by means of a systematic review based on the analysis of 42 high-quality articles found in the PUBMED, VHL and MEDLINE databases, selected after applying strict exclusion criteria divided into three stages, this review aims to evaluate the most relevant information on the topics covered, compare them with each other and summarize the possible conclusions.  RESULTS AND DISCUSSION: At the end of the analysis, it was found that, in fact, IBRs are associated with faster recovery and return to activities when compared to flaps such as TRAM or DIEP which, due to their greater surgical complexity, have a longer recovery time, with less mobility and greater associated pain, especially in the donor tissue area. On the other hand, patients undergoing RA have a higher degree of satisfaction in terms of aesthetics, despite an increased risk of serious complications. Despite the clear differences, the evidence shows that both IBR and RA have a similar impact on quality of life and there is no evidence to show that one method is superior to the other. Similarly, there is still a lack of robust evidence to prove the efficacy of Acellular Dermal Matrix, since the existing references are inconclusive as to the advantages of the method, and nevertheless point to a greater risk of local complications associated with its use, such as necrosis or infection. Regarding the use of implants in patients undergoing radiotherapy, the time of irradiation - before or after the reconstruction procedure - shows no significant difference in terms of the aesthetic or functional results obtained. However, this topic still lacks significant evidence and more studies are needed to reach definitive conclusions capable of systematizing clinical decisions. With regard to the post-operative period, it is clear that, in addition to the technique chosen, factors such as early mobilization, physical condition, post-operative care and physiotherapy have a significant impact on recovery and the time taken to return to activities, making it clear that a multidisciplinary care network is of unparalleled importance for early recovery. CONCLUSION: Breast reconstruction with implants (IBR) and flaps (AR) has advantages and disadvantages. RA offers natural aesthetic results, but involves risks such as thrombosis, while IBR is less invasive, but may not meet aesthetic expectations and has a higher risk of failure. In radiotherapy patients, IBR faces challenges due to tissue compromise. Recovery time varies: IBR is faster, while AR is more complex. The DIEP flap offers less pain. Acellular dermal matrix (ADM) can improve healing, but the results are inconclusive, and its indication should be cautious. The choice between IBR and RA depends on the patient's preferences and medical assessment.