Experience in dermomyofascial pouch coverage of immediate implants following skin sparing reduction mastectomy

Abstract

Mastectomy for breast cancer treatment and prophylaxis has improved survival for patients. The advantage of implant reconstruction post mastectomy is that it avoids an additional donor site with its associated morbidity, which post-mastectomy autologous reconstruction necessitates. However, the deficiency of muscle coverage at the lower pole of the implant meant it relied on only skin envelope coverage, and thus has the established complication of implant exposure or infection should the skin break down. In 2006, Nava devised a technique for a single-stage reconstruction using definitive breast implants with two-layer coverage of the lower pole with a vascularized dermal layer, as well as the traditional skin envelope, in women with preoperative large ptotic breasts. We present our experience with single-stage implant breast reconstruction using this technique. A retrospective review of the medical and operative records as well as patients' photographs was undertaken for consecutive patients from November 2009 to April 2011. These patients were selected for the procedure based on set criteria. We describe our surgical technique for this procedure. In the 18-month period, 6 patients underwent 11 skin sparing reduction mastectomy (SSRM) implant reconstructions. Follow-up ranged from 5 to 19 months. The mean length of hospital stay was 7.2 days (range was 2-15 days). One breast out of 11 reconstructions developed an infected seroma 8 months post-operatively, requiring aspiration and intravenous antibiotics. One breast out of 11 developed T junction skin necrosis and associated cellulitis but the breast implant was protected by a visibly vascularized dermal flap and, thus, was not exposed. One breast developed a minor vertical wound dehiscence. In our initial experience, SSRM is a safe and effective method of immediate implant-based breast reconstruction.