Hybrid breast reconstruction: a systematic review of current trends and future directions

Abstract

Background: Hybrid breast reconstruction involves the use of both autologous tissue and prosthetic implants to reconstruct the breast. This article presents a systematic review of the literature on hybrid techniques for post-mastectomy breast reconstruction. Methods: PubMed, EMBASE, Cochrane, and Web of Science were comprehensively searched for all English-language articles on hybrid breast reconstruction, using specific MeSH terms. Studies discussing indications and operative techniques for hybrid breast reconstruction, as well as clinical and patient-reported outcomes after hybrid reconstruction were reviewed. Results: In total, 575 articles were identified, of which 55 were selected for inclusion. Risk of bias was low for 45 studies and moderate for 10 studies. All articles provided operative details regarding hybrid reconstruction and assessed postoperative complications. Thirty-five studies also provided patient-reported outcomes and 27 studies commented on surgical indications/patient selection. Discussion: Ultimately, hybrid breast reconstruction confers the greatest utility when there is a mismatch between patients’ desired breast size and availability of autologous tissue. This is especially the case in patients who require radiotherapy, given that the vascularized flap may protect against adverse effects of irradiation on implants. While the latissimus dorsi (LD) myocutaneous flap augmented with implants has been a workhorse in hybrid breast reconstruction for many years, more recent literature has also demonstrated successful hybrid reconstruction with abdominally-based free flaps in combination with either saline or silicone implants. In addition, the use of mesh and/or acellular dermal matrix (ADM) has allowed for safe prepectoral implant placement in hybrid reconstructions, without compromising the vascular pedicle of the flap. With regards to timing of reconstruction, immediate, delayed-immediate (i.e., with immediate tissue expander placement) and delayed hybrid techniques have been reported. Overall, hybrid breast reconstruction has been demonstrated to improve clinical outcomes and decrease rates of reconstructive failure when compared to prosthetic reconstruction alone, especially in irradiated patients. Additionally, patient-reported satisfaction with hybrid breast reconstruction techniques has been high. Future research should focus on further improving clinical and aesthetic outcomes of this reconstructive technique. For instance, the authors describe a novel hybrid technique incorporating adjustable saline implants with flaps, to allow for refinement of hybrid breast volumes without requiring additional surgery.