Background
Immediate breast reconstruction using a dermal sling combined with a tissue expander is a well-established method, suited for large or ptotic breasts. However, the traditional technique involves a wise-pattern incision, which poses risks of T-junction breakdown. We present a modified dermal sling technique that eliminates the need for this additional incision, thus reducing such risks.
Method
We conducted a retrospective study on patients undergoing this modified technique at Dunedin Hospital from 2013 to 2022. Patient demographics, peri-operative data, complications, and follow-up were recorded. Skin sparing mastectomy without nipple preservation was performed by the breast surgeons, followed by the plastic surgeons placing a subpectoral expander or implant. De-epithelialised inferior mastectomy flap (dermal sling) was sutured to the inferior border of pectoralis major to cover the expander/implant in entirety. Then the superior mastectomy flap is draped over the dermal sling and sutured to the inframammary fold (IMF) without a wise-pattern incision.
Results
There were 43 female patients (75 breasts) and the mean age was 47.1 (range 25 – 66). Twenty-seven were post-oncologic reconstructions and 48 were prophylactic. The mean BMI was 28.7, there were no smokers, one was a diabetic, nine had neo-adjuvant chemotherapy and four had neo-adjuvant radiotherapy. The mean mastectomy weight was 843g. Forty-one went direct to implant (mean 448cc) and 34 had expanders with on-table expansion (mean 224cc) and subsequent exchange to implant (mean 539cc). Mean follow up was 33.4 months and the average number of operations per patient was 2.23. Implant/expander loss rate due to infection was 5.3%, seroma rate was 4%, one delayed wound healing and one haematoma requiring return to theatre.
Conclusion
Our modified dermal sling technique offers a valuable alternative for immediate breast reconstruction in patients with large or ptotic breasts, with reliable outcomes and no risk of T-junction breakdown associated with traditional methods.