Outcome after autologous dermal sling-assisted immediate breast reconstruction

Abstract

In selected patients undergoing mastectomy and immediate reconstruction, a de-epithelialized skin flap (dermal sling) may be used to complete the submuscular pocket. This study examined the safety and efficacy of an autologous dermal sling in providing inferolateral support to the implant or tissue expander during immediate breast reconstruction. Patients were identified from an electronic prospective database. Records of all patients were reviewed for details of management, complications and follow-up. Patient satisfaction and quality of life in the postoperative period were determined using the BREAST-Q(©) questionnaire. Between October 2008 and August 2010, 21 patients underwent 28 dermal sling-assisted breast reconstruction procedures. Their median age was 48 (range 30-70) years. Median hospital stay was 5 (range 3-7) days. Drains were removed at a median of 5 (range 3-7) days after surgery. During the operation a median volume of 150 ml was added to the tissue expander. The most common postoperative complication was superficial -junction breakdown in five patients, followed by seroma and infection each in three patients, but no implant required removal. BREAST-Q(©) responses indicated a high level of satisfaction overall with the reconstructed breast. Dermal sling-assisted immediate breast reconstruction has a low serious complication rate, provides stable soft tissue cover for the tissue expander and is associated with a high level of patient satisfaction. A larger pocket can be created, permitting more fluid to be added to the expander.