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Page 2 of 16 Allam et al. Plast Aesthet Res 2024;11:19 https://dx.doi.org/10.20517/2347-9264.2024.21

treatments has notably increased survival rates for breast cancer patients, consequently shifting the
[2]
treatment paradigm from focusing on mortality reduction to enhancing quality of life . Evidence has
shown that women who undergo surgical resection without reconstruction report more negative
[3]
perceptions of body image, lower self-esteem, and increased feelings of anxiety postoperatively . In this
regard, breast reconstruction has offered patients the opportunity to improve their quality of life .
[3]
Among the various reconstruction techniques, autologous breast reconstruction is frequently preferred by
patients, owing to its natural appearance without the use of prosthesis . Autologous breast reconstruction is
[4]
especially appreciated for its advantageous use in adjuvant radiation therapy and its ability to better match
the contralateral native breast in unilateral reconstructions. This approach is also often preferred over
implant-based reconstruction due to a better complication profile, including less capsular contracture,
infection, and the potential future need for implant replacement .
[5]
Despite its benefits, however, autologous reconstruction is not without limitations: Autologous breast
reconstruction-commonly performed with a deep inferior epigastric artery perforator (DIEP) flap-is a
technically difficult and lengthy procedure associated with the risk of complications, such as hematoma,
skin necrosis, and notably, donor site morbidity. Currently, there has been a trend toward
perforator-to-perforator DIEP to minimize donor site morbidity, which underscores the necessity for
enhanced imaging, refined robotics, and more intricate technological advancements .
[6-8]
Recent technological advancements demonstrate remarkable applications in three crucial aspects of
perioperative in autologous breast reconstruction, namely: (i) preoperative planning; (ii) intraoperative
technique; and (iii) postoperative monitoring. Concurrently, the evolution of surgical techniques demands a
corresponding adaptation in educational methods to address increasing surgical complexity. This article
aims to review and discuss the latest advances in technology and their application in autologous breast
reconstruction, highlighting recent developments and their utility in perioperative management and
surgical education [Figure 1].

PREOPERATIVE PLANNING
Background
Autologous breast reconstruction most frequently utilizes abdominally-based flaps, such as the
aforementioned DIEP flap. Variations in perforator anatomy increases the complexity of these procedures,
increasing operative time as well as the risk of intraoperative errors and postoperative complications .
[9]
Preoperative evaluation of flap and perforator selection is, therefore, key to optimizing patient outcomes
and efficiency in the operating room.

Inadequate perforator selection can lead to postoperative complications such as hematoma, thrombosis, fat
necrosis, and complete flap loss. Current methods of preoperative evaluation herald MRI angiography
(MRA), CTA, and Doppler ultrasound as the gold standard. However, postoperative complications still
[7]
occur relatively frequently even with the use of these preoperative imaging modalities . In addition, the use
of standard preoperative evaluation methods results in changes in surgical plan intraoperatively in nearly
25% of cases, which prolongs operative time, increasing the risk to the patient and financial burden .
[10]
Recent advancements in 3D printing, augmented reality, and artificial intelligence have been applied to
autologous breast reconstruction to address these limitations to improve complication risk and optimize
efficiency in the operating room [11-13] .