Editorial: Recent Innovations in Breast Reconstructive Surgery: a Continuous Debate

Andrea Lisa^*

• Istituto Europeo di Oncologia, Milan, Italy

At the heart of current innovation is a growing effort to personalize reconstruction, aligning technique with patient anatomy, oncologic safety, and aesthetic expectation. This is particularly evident in studies exploring newer approaches such as robotic-assisted procedures and pre-pectoral implant placement. González et al. introduced the use of robotic-assisted latissimus dorsi-flap reconstruction, demonstrating how technology can reduce donor site morbidity and potentially refine operative precision. Simonacci et al. added to this discussion by exploring the outcomes and indications of pre-pectoral prosthetic reconstruction, a technique gaining traction for its potential to reduce postoperative discomfort and improve cosmetic outcomes. Together, these studies point to a future where minimally invasive and muscle-sparing approaches may become the new standardprovided they are supported by long-term data and careful patient selection.But surgical innovation is only one part of the equation. A parallel trend is the shift toward more rigorous, objective, and patient-centered methods of outcome assessment. Di Taranto et al. made a compelling case for the integration of 3D surface imaging into postoperative evaluations. Their work illustrates how advanced imaging can help quantify aesthetic results, reduce subjective bias, and enhance both patient satisfaction and clinical decision-making. This emphasis on measurable aesthetic outcomes is echoed in the work of Pignatti et al., who investigated contralateral symmetrization strategies and highlighted the importance of achieving visual harmony-not just for appearance but also for psychological recovery and self-image.Patient-reported outcomes further reinforce the multidimensional nature of reconstructive success. Lopez et al. utilized the BREAST-Q to assess satisfaction in women undergoing nipple-sparing mastectomy with reconstruction, showing how validated tools can capture the nuanced experience of patients navigating both cancer treatment and surgical recovery. Their findings underscore that aesthetic satisfaction must be considered alongside emotional well-being, sexual identity, and the restoration of normalcy.Functional outcomes, too, are increasingly recognized as essential components of comprehensive care. Xie et al. explored the biomechanical effects of external breast prostheses, showing how posture and physical adaptation are shaped by reconstruction-or its absence. This attention to bodily integrity extends the conversation beyond the surgical site and into the broader physical experience of survivorship.Finally, the work of Manconi et al. reminds us that innovation must always be balanced against safety. Their analysis of complications across reconstructive modalities contributes valuable data to help clinicians counsel patients, manage expectations, and make informed decisions about technique selection.Taken together, these seven contributions reveal a field that is both technologically ambitious and deeply reflective-driven by a desire to optimize outcomes, minimize harm, and restore not only form but identity. The debate, as the title of this Topic suggests, is continuous. But it is also constructive, with each new insight refining our understanding of what reconstruction can and should be.