Dual Coverage of the Inferior Pole with Conjoined Fascial Flap and Acellular Dermal Matrix for Immediate One-Stage Breast Reconstruction with a Prosthetic Implant.

Abstract

Elevation of a conjoined fascial flap composed of the pectoralis major, serratus anterior, and external oblique fascia is a type of surgical technique using autologous tissue to cover the lower pole after immediate one-stage direct-to-implant (DTI) breast reconstruction. However, volumetric breast implants hinder use of this technique alone. For better structural stability and more aesthetically favorable breast contour in large breasts, we have devised a technique involving dual coverage of the lower pole by a conjoined fascial flap and acellular dermal matrix (ADM). Twenty Asian patients underwent DTI breast reconstruction from March 2013 to May 2014. ADM was used to cover the inferomedial quadrant of the breast, and a conjoined fascial flap was elevated to cover the remaining inferolateral quadrant. Both patient- and plastic surgeon-reported outcome measures were assessed using questionnaires. For every domain of the patient- and plastic surgeon-reported questionnaires, the mean scores were between satisfied and very satisfied. Two patients developed a seroma and one patient developed partial skin flap necrosis. Both seromas resolved after a series of aspirations. The necrotic skin flap was revised under local anesthesia 3weeks after the reconstructive surgery. The use of dual coverage of the inferior pole with a conjoined fascial flap and ADM for immediate DTI among patients with large breasts is supported by high scores in both patient- and plastic surgeon-reported outcome measures, as well as low complication rates. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .