Breast reconstruction: from the prepectoral technique to hybrid reconstruction

Breast reconstruction is today one of the most innovative and rapidly evolving fields in plastic surgery. Dr. Giorgio Berna, Director of the Plastic Surgery Unit at the Regional Hospital of Treviso and board member of SICPRE (the Italian Society of Plastic, Reconstructive, Aesthetic, and Regenerative Surgery), discusses this topic in depth.

«The main innovation is the prepectoral reconstruction – explains Berna – It’s a technique developed in our department in collaboration with colleagues from Bristol, and it has since spread worldwide from 2012 to today».

The surgeon emphasizes that this is a more physiological approach: «The implant is placed where the breast naturally was, preserving the pectoral muscle. This ensures faster healing, less postoperative pain, and an earlier return to normal activities».

Alongside this, hybrid reconstruction is becoming increasingly common, a combination of implants and lipofilling. «This involves inserting an implant combined with fat grafting, which allows us to correct small imperfections, especially at the upper inner pole near the sternum, in slimmer patients».

Immediate breast reconstruction and the fat tissue bank

In recent years, immediate reconstruction has become increasingly widespread. «In our hospital, we perform 96–98% immediate reconstructions, – says Berna – This is possible thanks to advances in breast surgery, which allow immediate placement of an implant in a prepectoral plane. As I like to say, patients enter sick and leave healthy, and it’s also a significant cost saving for the healthcare system».

Autologous fat remains a valuable resource. «Being able to use the patient’s own tissue is a great advantage – the surgeon explains – In Treviso, we have created a Tissue Bank that stores fat harvested in a single procedure and redistributes it across multiple sessions. This allows us to avoid general anesthesia for subsequent interventions and turn them into outpatient procedures, which is a major benefit for patients».

Finally, Berna stresses the importance of postoperative care. «It’s essential to follow patients closely after surgery, from the bra, which we apply directly in the operating room, to drain management and psychological and family support. Breast reconstruction is not just a surgical act: it’s a gesture of care, trust, and rebirth».

Equal access and a culture of awareness

Despite progress, inequalities persist between regions. «The goal is to ensure equal treatment for all patients, from North to South – Berna explains – Not every center has a dedicated plastic surgeon, and that makes a difference in outcomes and complication rates. SICPRE is working to ensure that every Breast Unit includes all the necessary specialists».

Every year, SICPRE promotes BRA Day, the international day dedicated to raising awareness about breast reconstruction.

The initiative, held in over thirty countries, aims to inform and support women undergoing cancer treatment, helping them understand the options offered by reconstructive plastic surgery after mastectomy and to overcome fears and misconceptions. «BRA Day is an internationally significant event, a day dedicated to awareness about breast reconstruction – says Berna – This year it will be held on October 15 in Rome; last year, I had the honor of organizing it in Treviso. It was a wonderful, engaging event with the participation of women and professionals from all the Breast Units. Patients can follow it live or later on SICPRE’s YouTube channels. Don’t miss this opportunity, it’s information created by Italian plastic surgeons especially for you».