inates muscle manipulation while producing more natural breast contour and movement.
The shift has been made possible largely through the development of acellular dermal matrix( ADM), a biologic scaffold derived from processed human or animal tissue. ADM provides soft-tissue support, improves implant positioning and significantly reduces rates of capsular contracture.
“ The mesh actually modifies how the myofibroblast activity happens after reconstruction,” Dr. Wermeling explained, noting that vascular ingrowth into the matrix helps maintain a softer, more pliable capsule around implants.
Collaboration Drives Better Outcomes
Throughout the presentation, Dr. Wermeling repeatedly stressed the importance of multidisciplinary collaboration between plastic surgeons and breast oncologic surgeons.
Successful prepectoral reconstruction depends heavily on careful preservation of mastectomy skin and subcutaneous tissue during cancer surgery. Thin or poorly perfused skin flaps dramatically increase the risk of wound complications and implant exposure.
“ I work with people that I trust, and we share an outlook on how patients are going to do from a holistic perspective,” he said.
Patient selection also remains critical. Dr. Wermeling generally avoids immediate reconstruction in active smokers and prefers diabetic patients to maintain a hemoglobin A1C below 7 before surgery. For patients who are not ideal candidates for immediate reconstruction, delayed staged reconstruction can still provide excellent outcomes once tissues recover.
Expanding Options with Autologous Reconstruction
While implant-based reconstruction remains common, Dr. Wermeling also discussed advances in autologous free flap procedures for patients who prefer to avoid implants or lack adequate mastectomy skin quality.
Modern microsurgical techniques now allow surgeons to preserve far more abdominal muscle than earlier TRAM flap procedures, reducing abdominal wall morbidity while maintaining excellent reconstructive results.
Using perforator-based approaches such as DIEP flaps( Deep Inferior Epigastric Perforators), surgeons can transfer tissue from the abdomen to the chest while leaving most of the rectus muscle intact.
“ Eliminating the muscle from autologous reconstruction has been a huge advancement in patient outcomes,” Dr. Wermeling said.
A Field Continually Advancing
Today’ s reconstructive strategies prioritize not only cancer treatment, but also function, appearance and emotional recovery, a transformation that continues to evolve as technology and collaboration advance.
For physicians caring for breast cancer patients, Dr. Wermeling’ s message was clear: reconstruction is no longer simply about replacing lost tissue. It is about restoring quality of life through individualized, multidisciplinary care.
www. sciencedirect. com / science / article / abs / pii / S1748681525001500
pmc. ncbi. nlm. nih. gov / articles / PMC11355501 /
This summary was generated by AI transcription software based on the live presentation delivered during the GLMS Foundation’ s Senior Physician Speaker Series. Thank you to Dr. Sam Yared for reviewing and adding insights to this summary.
GLMS Foundation Senior Physicians Speaker Series
Make sure to add these dates to your calendar so you don’ t miss out! June 2, August 4, September 2, October 6 and December 1
All meetings will take place at noon via Zoom. The program is free and open to GLMS members and their guest. Please contact us for more information on the programs and how to access the meetings. Senior Physicians Committee Chair, Dr. Sam Yared, has several speakers already lined up, but is always looking for new ideas. If you have suggestions on potential speakers or topics, please reach out, we would love to hear your ideas! Missed a recent program and want to catch up? Contact us for a link to the recordings. foundation @ glms. org | 502-736-6366
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