E1824. Updates in Imaging of Breast Reconstruction
  1. Risha Shah; Mallinkrodt Institute of Radiology
  2. Alexandra Keane; Washington University Dept. of Plastic Surgery
  3. Debbie Bennett; Mallinkrodt Institute of Radiology
Breast cancer is the second most common cancer worldwide and the most common cancer among women. In the United States, in particular, 1 in 8 women will be diagnosed with invasive breast cancer in their lifetime and 1 in 39 women will die from the disease. Over the last few decades, multiple advances in diagnostic and therapeutic methodology, including the advent of neoadjuvant chemotherapy, have made it possible for patients to be increasingly treated with breast conserving surgery (BCS). Despite equivalent survival when combined with radiation therapy, however, BCS-eligible patients are increasingly electing for mastectomy with breast reconstruction (BR). Understanding the types of and new innovations in BR and their various presentations on imaging, therefore, is critical for breast radiologists.

Educational Goals / Teaching Points
There are 2 broad categories of breast reconstruction: implant-based and autologous flap reconstruction, the former being the most predominant technique used in the United States. Advances in implant-based reconstruction (IBR), including the advent of the acellular dermal matrix (ADM), have allowed breast surgeons to preserve the pectoralis muscle, utilizing a pre-pectoral approach with better cosmetic outcomes. Similarly, new innovations in microsurgical techniques have made abdominal-based, muscle-sparing flaps the criterion standard for autologous breast reconstruction. Fat grafting and oncoplastic reduction are additional adjunctive techniques that can further improve patient outcomes. BR-related complications include flap loss, infection, seroma, hematoma, fat necrosis, implant rupture, capsular contracture, wound healing issues, tumor recurrence, and the rare occurrence of breast implant associated anaplastic large cell lymphoma.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Without knowledge of the most current surgical BR techniques, normal postoperative imaging findings can be mistaken for concerning, pathological processes. This, in turn, can lead to superfluous imaging, added costs, and higher distress for the patient. Different modalities also play complementary roles in imaging the reconstructed breast. For example, while ADM is best evaluated via ultrasound, fat necrosis can often be definitively diagnosed via mammogram.

BR after mastectomy is often requested by women with breast cancer. Current BR techniques are diverse and may involve the use of autologous tissue, an implant, or both. Breast radiologists, therefore, should be knowledgeable about normal and abnormal findings that may arise from BR.