The Benefits and Pitfalls of Using an Autologous Dermal Flap in Immediate Implant-Based Reconstruction.

Natalia L Garibotto

doi:10.7759/cureus.14144

Abstract

One of the challenges of implant breast reconstruction post-subcutaneous mastectomy is coverage of the inferior pole of the implant to provide a barrier between the implant and skin. Numerous biological and synthetic meshes are available on the market for this purpose; however, they are often very costly and carry all the risks of using a foreign body. In patients with large ptotic breast, the skin of the inferior mastectomy flap can be used instead. A number of techniques and variations have been developed over the last 40 years driven by the increasing cost of healthcare and acceptance of breast reconstruction as vital part of breast cancer care and survivorship. This review outline the benefits and pitfalls of using an autologous dermal flap in breast construction and the variations in published use.

Highlights

The use of an autologous dermal sling (DS) created from the de-epithelialized skin of an inferior mastectomy flap is sometimes described as the Bostwick technique after it was described in a plastic surgery textbook in the 1990s [1]
This description covered an immediate implant with two layers of vascularized tissue after a ‘Wise pattern’ mastectomy with a free nipple graft
An autologous dermal flap (ADF) can be used in the technique above (‘classic’ DS) or with a non-Wise pattern mastectomy. It can be used in conjunction with a synthetic mesh or acellular dermal matrix (ADM), with or without an implant, or as a buttress for a suture line or T-junction

Summary

Introduction

The use of an autologous dermal sling (DS) created from the de-epithelialized skin of an inferior mastectomy flap is sometimes described as the Bostwick technique after it was described in a plastic surgery textbook in the 1990s [1]. An ADF (termed a DS in this paper) can be used in the technique above (‘classic’ DS) or with a non-Wise pattern mastectomy It can be used in conjunction with a synthetic mesh or acellular dermal matrix (ADM), with or without an implant, or as a buttress for a suture line or T-junction. A literature review performed by a U.S group comparing ADM in patients undergoing a single-staged immediate breast reconstruction demonstrated a cost benefit to using an ADF [4] This cost benefit was durable, with a complication rate of up to 20%. Nava et al [10] adopted the single-stage reconstruction with a direct to permanent implant in 2006, which is widely quoted in much of the following literature [7,19,20] They have published further papers on this technique [21] always using a subpectoral pocket. The use of an ADF may be beneficial in this circumstance; it still relies on coverage of the implant with irradiated tissue

Conclusions

Findings

Disclosures