Implant-Based Breast Reconstruction

  • Cagri Cakmakoglu
  • Thomas Y. Xia
  • Risal S. Djohan
  • Graham S. SchwarzEmail author


Implant-based breast reconstruction is the most frequently employed breast reconstruction approach due to its relative technical ease and short postoperative recovery. In particular, increasing usage of both direct-to-permanent implant placement and pre-pectoral positioning of breast implants necessitate a trustworthy test for mastectomy skin flap perfusion.

Intraoperative identification of potentially ill-perfused mastectomy skin flaps with indocyanine green angiography allows for preventative excision of inadequately perfused skin. In cases of implant-based breast reconstruction, the reconstruction technique will include placement of a full-sized, heavier, permanent implant or a partially deflated expander, which can be securely inflated to its full volume over time as satisfactory mastectomy incisional healing and skin envelope viability are demonstrated. If a wide area of skin has low perfusion, pre-pectoral or partial, sub-pectoral device placement can be changed to complete, sub-muscular expander breast reconstruction with minimal volume fill.


Breast reconstruction Indocyanine green Mastectomy skin necrosis Breast reconstruction algorithm Mastectomy skin flap Implant-based breast reconstruction 

Supplementary material

Video 28.1

Case 1 (MP4 71586 kb)

Video 28.2

Case 2 (MP4 38916 kb)


  1. 1.
    Sue GR, Long C, Lee GK. Management of mastectomy skin necrosis in implant based breast reconstruction. Ann Plast Surg. 2017;78(5 Suppl 4):S208–11. Scholar
  2. 2.
    Jones G. Bostwick’s plastic and reconstructive breast surgery. NY, USA: Thieme Medical Publisher Inc.; 2009.Google Scholar
  3. 3.
    Jeon FHK, Varghese J, Griffin M, Butler PE, Ghosh D, Mosahebi A. Systematic review of methodologies used to assess mastectomy flap viability. BJS Open. 2018;2(4):175–84. Scholar
  4. 4.
    Mattison GL, Lewis PG, Gupta SC, Kim HY. SPY imaging use in postmastectomy breast reconstruction patients: preventative or overly conservative? Plast Reconstr Surg. 2016;138(1):15e–21e. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Cagri Cakmakoglu
    • 1
  • Thomas Y. Xia
    • 2
  • Risal S. Djohan
    • 1
  • Graham S. Schwarz
    • 1
    Email author
  1. 1.Department of Plastic SurgeryCleveland ClinicClevelandUSA
  2. 2.School of MedicineCase Western Reserve UniversityClevelandUSA

Personalised recommendations