SH15 THE EVOLUTION OF BREAST RECONSTRUCTION

Mastectomy is frequently used in the treatment and prophylaxis of malignant breast disease, thus reconstruction of the breast has become a significant part of the management of breast cancer. With advances in anatomical knowledge, surgical techniques and prostheses, a multitude of options for reconstruction have surfaced. These options have provided improvements in cosmetic outcome, operative recovery and operative morbidity. Attempts at achieving optimal breast reconstruction has progressed greatly from the transfer of a lipoma in 1895, to the current use of free tissue transfer. Autologous reconstruction has evolved such that the reconstructive surgeon can choose from pedicled transfer of rectus abdominis, to the free transfer of gracilis. Implant based techniques have come far since the initial use of paraffin injections in 1889, to the current use of tissue expanders and saline implants. Endoscopic techniques have recently gained popularity, offering patients minimized operative morbidity, reduced hospital stay and reduced scar formation. As the search for optimal breast reconstruction continues, the concept of tissue engineering offers yet another pathway to achieving near normal anatomy for the patient. Human mesenchymal stem cells differentiated into adipocytes have successfully been grown into pre‐defined shapes using cell‐scaffold constructs, or hydro‐gels, however generating an adequate blood supply to sustain an adipose unit of clinically significant size remains a challenge. This paper serves to acknowledge the significant contributions made by our predecessors to the art of breast reconstruction, as well as offer an insight to the prospects for its future.