From Awareness to Advancement: The Breast Reconstruction Issue

October marks Breast Cancer Awareness Month and Breast Reconstruction Awareness (BRA) Day. The editors of Plastic and Reconstructive Surgery have cultivated a set of original articles for publication in this month's Journal. The articles reflect what is new in breast reconstruction and the latest outcomes research. While it is impossible to highlight everything current with respect to plastic surgery of the breast, the editors have amassed a group of relevant articles to highlight this important month. October has been designated as National Breast Cancer Awareness Month for nearly 4 decades. As noted by the Susan G. Komen Foundation, "It is a time annually devoted to educating everyone about breast cancer—including metastatic breast cancer—and the importance of early detection and access to timely, high-quality care."1 One in 8 women is diagnosed with breast cancer in her lifetime. Advancing age and female sex are the 2 greatest risk factors for developing breast cancer. Breast Cancer Awareness Month is a call to action for women to be educated about breast cancer and a push for breast cancer screening, so that women know their own normal and recognize when to talk to a health care provider if something does not feel or look right. It is a reminder to make healthy lifestyle choices and to take action. October is also home to BRA Day. On October 19, 2011, Canadian plastic surgeon Mitchell Brown, MD, hosted an event at Women's College Hospital and Toronto General Hospital titled "Breast Reconstruction: An Evening of Learning and Sharing."2 Dr. Brown had noticed that many Canadian women who underwent mastectomy for breast cancer resisted breast reconstruction. The purpose of the event was to educate patients and physicians about the availability of breast reconstruction. BRA Day is intended to raise awareness about breast cancer, the need for screening and self-examination, and the availability of breast reconstruction. BRA Day was adopted in the United States in 2012.3 This issue of the Journal focuses on many relevant topics in breast surgery and reconstruction. Nipple-sparing mastectomy and prepectoral implant placement have become very popular. While prepectoral reconstruction results in improved physical well-being of the chest for patients, it also comes with a higher complication rate, as reported by Wang et al.4 The group also evaluated artificial intelligence and machine learning to predict complications in alloplastic breast reconstruction. They found that body mass index, prepectoral expander placement, and chemotherapy are important predictors of tissue expander complications. Smith and colleagues utilized Markov Chain Monte Carlo simulation to determine the cost effectiveness of prophylactic mastectomy and autologous reconstruction in a large group of BRCA1- and BRCA2-positive patients.5 They found that in patients younger than 40, prophylactic mastectomy and autologous reconstruction were more cost effective than breast cancer surveillance and disease treatment. Patients with a genetic predisposition to breast cancer who are considering risk-reducing mastectomy are frequently interested in nipple-sparing mastectomy. Unfortunately, not all women are candidates, due to breast size or nipple position. Gibson et al. performed a systematic review and meta-analysis of patients who underwent staged breast reduction and mastopexy before nipple-sparing mastectomy.6 The balance of original articles in this issue covers a range of topics, including robot-assisted mastectomy and deep inferior epigastric perforator (DIEP) flap reconstruction, a new method of minimally invasive DIEP flap harvest to avoid injury to motor nerves supplying the lower rectus muscle, safely augmenting DIEP flaps with smooth implants in the prepectoral plane, a long-term critical evaluation of superior pedicle breast reductions, and an investigation into the quality of breast reconstruction reporting outcomes. Breast cancer awareness is important every day of every month of the year. October marks a special time when there is more media coverage of this important topic. Publishing a larger group of original breast-related articles in Plastic and Reconstructive Surgery highlights the importance of Breast Cancer Awareness Month and BRA Day. DISCLOSURE The author has no financial relationships or conflicts of interest to disclose.