Innovations and Clinical Outcomes in Advanced Oncologic Reconstruction: Contemporary Approaches for Postmastectomy and Skin Cancer Patients
DOI:
https://doi.org/10.64784/232Palabras clave:
advanced reconstruction, breast reconstruction, postmastectomy reconstruction, skin cancer reconstruction, reconstructive oncology, microsurgery, local flaps, acellular dermal matrix, quality of life, patient-centered outcomes, regenerative medicine, tissue engineering, oncologic surgery, breast cancer, cutaneous malignanciesResumen
Advanced reconstruction has become an essential component of modern oncologic care, particularly for patients undergoing mastectomy for breast cancer and those requiring reconstruction following skin cancer excision. The objective of this review was to analyze contemporary evidence regarding reconstructive strategies, clinical outcomes, patient-centered benefits, and emerging innovations in reconstructive oncology. A narrative and integrative literature review was conducted using scientific publications retrieved from major biomedical databases, including PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar. The reviewed evidence demonstrated that implant-based reconstruction, autologous tissue reconstruction, microsurgical procedures, local flaps, skin grafting techniques, and acellular dermal matrix-assisted approaches constitute the principal reconstructive modalities currently employed in oncologic practice. Implant-based reconstruction remains the most widely utilized option, whereas autologous and microsurgical techniques frequently provide superior long-term aesthetic and functional outcomes. In dermatologic oncology, local flap reconstruction continues to represent a highly effective solution for restoring complex anatomical regions while preserving function and cosmetic appearance. Patient-centered outcomes, including quality of life, body image, emotional well-being, social reintegration, and long-term satisfaction, were consistently identified as important indicators of reconstructive success. The findings also highlight the growing importance of multidisciplinary collaboration and individualized treatment planning in optimizing outcomes. Emerging technologies such as regenerative medicine, tissue engineering, bioengineered scaffolds, three-dimensional surgical planning, and artificial intelligence-assisted decision-making may further enhance reconstructive precision and patient care in the future. Overall, advanced reconstruction plays a critical role in improving functional recovery, aesthetic restoration, psychosocial adaptation, and survivorship among patients affected by breast cancer and cutaneous malignancies.
Referencias
• Barrios, C., et al. (2022). Barriers and facilitators to provide multidisciplinary care for breast cancer patients in five Latin American countries. Journal of Global Oncology, 8, e2200123.
• Bittner, G. C., Cerci, F. B., Kubo, E. M., & Tolkachjov, S. N. (2021). Mohs micrographic surgery: A review of indications, technique, outcomes, and considerations. Anais Brasileiros de Dermatologia, 96(3), 263–277.
• Chung, A. M., et al. (2019). The effect of postmastectomy radiation therapy on breast reconstruction using acellular dermal matrix: A systematic review. Gland Surgery, 8(4), 397–405.
• Clarijs, M. E., et al. (2023). Quality of life and complications after nipple- versus skin-sparing mastectomy followed by immediate breast reconstruction. Annals of Surgical Oncology, 30, 590–600.
• Cook, H. I., et al. (2024). Does the use of acellular dermal matrices in women undergoing immediate implant-based breast reconstruction affect surgical outcomes? A systematic review. The Breast, 76, 103749.
• DeLong, M. R., Tandon, V. J., Rudkin, G. H., Da Lio, A. L., & Wirth, G. A. (2019). A systematic review of the impact of acellular dermal matrix on aesthetics and patient-reported outcomes in tissue expander-to-implant breast reconstruction. Plastic and Reconstructive Surgery, 144(5), 967e–974e.
• Desisto, N. G., et al. (2023). State of the evidence for facial skin cancer reconstruction. Facial Plastic Surgery Clinics of North America, 31(4), 533–548.
• Endara, M., Chen, D., Verma, K., Nahabedian, M. Y., & Spear, S. L. (2013). Breast reconstruction following nipple-sparing mastectomy: A systematic review of the literature with pooled analysis. Plastic and Reconstructive Surgery, 132(5), 1043–1054.
• Faenza, M., et al. (2024). Functional and aesthetic comparison between grafts and local flaps in facial skin cancer reconstruction. Journal of Clinical Medicine, 13(17), 5065.
• Galimberti, V., Vicini, E., Corso, G., Morigi, C., Fontana, S., Sacchini, V., & Veronesi, P. (2017). Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications. The Breast, 34, S82–S84.
• Justo, N., Wilking, N., Jönsson, B., Luciani, S., & Cazap, E. (2013). A review of breast cancer care and outcomes in Latin America. The Oncologist, 18(3), 248–256.
• Lee, K. T., et al. (2023). Association of the breast reconstruction modality with the development of postmastectomy lymphedema. Plastic and Reconstructive Surgery, 151(6), 1171–1181.
• Margenthaler, J. A., et al. (2020). Oncologic safety and outcomes in patients undergoing nipple-sparing mastectomy. Journal of the American College of Surgeons, 230(4), 535–541.
• Meaike, J. D., Dickey, R. M., Killion, E., Bartlett, E. L., & Brown, R. H. (2016). Facial skin cancer reconstruction. Seminars in Plastic Surgery, 30(3), 108–121.
• Murphy, D., et al. (2023). Immediate breast cancer reconstruction with or without mesh support: A randomized clinical trial. JAMA Surgery, 158(5), 453–461.
• Regan, J. P., & Casaubon, J. T. (2023). Breast reconstruction. In StatPearls. StatPearls Publishing.
• Schaverien, M. V., & Coroneos, C. J. (2019). Surgical treatment of lymphedema. Plastic and Reconstructive Surgery, 144(3), 738–758.
• Schaverien, M. V., et al. (2021). Combined deep inferior epigastric artery perforator flap breast reconstruction and vascularized lymph node transfer. Plastic and Reconstructive Surgery, 147(3), 602–612.
• Tellarini, A., et al. (2023). Immediate post-mastectomy prepectoral breast reconstruction with animal-derived acellular dermal matrix: A systematic review. Journal of Clinical Medicine, 12(18), 5972.
• Vindigni, V., Bassetto, F., & Mazzoleni, F. (2024). Breast reconstruction: The oncoplastic approach. Medicina, 60(7), 1118.
