Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique

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Direct-to-implant (DTI) breast reconstruction after skin reducing mastectomy in large and ptotic breast is characterized by a high rate of complication. The Dermal Sling is commonly used to give extra coverage to the lower pole of the mammary implant to lower the risk of implant exposure in case of wound dehiscence at the T-junction. The aim of the paper is to detail an original technique that combines an inferior dermal sling with pectoral and serratus fascial flaps, to create a pre-pectoral pouch. We retrospectively review the clinical data of the patients who underwent Type IV/V mastectomy and DTI breast reconstruction with the described technique. Minor and major post operative complications were analyzed. Patient satisfaction and aesthetic outcomes were evaluated at one year of follow-up through Breast-Q and Validated Aesthetic Scale. Ten patients (fourteen breasts) were included in the study. Skin and/or NAC necrosis occurred in three breasts. One patient underwent implant removal due to periprosthetic infection. At one of follow-up no capsular contracture nor migration of the implant were clinically detected in all patients. One patient had a visible rippling at the upper quadrants of the new breast. Good patient satisfaction and aesthetic outcomes were reported. The association of fascial flaps and dermal sling is a viable option for breast reconstruction in patients with large and ptotic breasts. Along with providing an autologous coverage for the implant, it allows to maintain a good projection, maximize symmetrization in case of concomitant contralateral reduction mammoplasty and avoid any implant displacement.