Comparison of Using Autologous Dermal Flap and Absorbable Breast Mesh in Risk-Reducing Subcutaneous Mastectomy with Immediate Breast Reconstruction

Abstract

Introduction: In patients with large breasts undergoing a subcutaneous mastectomy with immediate implant-based reconstruction, it is often necessary to perform a mastopexy. The combination of these procedures increases the complication rate. To reduce it, it is necessary to cover the lower pole of the implant. Our study aimed to compare the use of an autologous dermal flap and an absorbable breast mesh. Materials and Methods: A total of 64 patients without previous breast surgery were divided into two groups, each with 32 patients. In the first group, the implant was covered with an autologous caudally based dermal flap, sutured to the great pectoral muscle. In the second group, the implant was covered with a fully absorbable breast mesh, fixed caudally in the inframammary fold and cranially to the great pectoral muscle. The incidence of complications, the aesthetic effect, and patient satisfaction were evaluated in a one-year follow-up. Results: In the first group, there were two cases of seroma, two partial nipple-areola complex necrosis, four cases of dehiscence in the T-suture, and the malposition of the implant in two patients. In the second group, there were two cases of seroma, two cases of T-junction dehiscence, and one case of full nipple-areola complex necrosis, which resulted in implant loss. There was no significant difference in patient satisfaction between the study groups. Conclusion: The dermal flap is more suitable for breasts with pronounced ptosis. The use of the synthetic mesh is suitable for smaller breasts, where the possible dermal flap would be too small to cover the implant.