Immediate reconstruction following prophylactic mastectomy for larger ptotic breasts is difficult. Tissue expansion in these patients often results in poor cosmetic outcomes. Autologous options may not be possible due to clinical unsuitability or patient choice. Using the inferior dermal flap with implant achieves lower pole fullness and allows a one-stop reconstruction in the larger ptotic breast.
The inferior dermal flap and implant was performed on ten patients (20 breasts). Average age was 43 (range 36–53). The average BMI was 37 (range 32–43). The distance from nipple to IMF varied from 15 cm to 26 cm. The average implant size was 533 (range 390–620). Complications were minimal with one patient experiencing delayed wound healing at the T-junction and one patient developing inferior pole erythema postoperatively that settled with antibiotics.
The inferior dermal flap and implant provides a one-stop reconstructive option. It is reliable, safe and maintains the breast envelope while giving excellent size, shape and symmetry in the larger ptotic patient.
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Published online: May 17, 2012
Accepted: March 26, 2012
Received: May 16, 2011
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
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- Reduction-pattern mastectomy: Vascularity of the inferior dermal flapJournal of Plastic, Reconstructive & Aesthetic SurgeryVol. 66Issue 4
- PreviewThe technique described in this article1 and previously2 has several features to commend it, not least the Gillies maxim, “never throw anything away”, to which might be added, “especially where the alternative is expensive”. Nevertheless, whilst we have also used the dermal flap in reduction-pattern mastectomy to good effect, we currently participate in the increasing trend towards the use of acellular dermal matrices (ADM) in single-stage breast reconstruction. Future analyses will determine whether completing inferior pole implant coverage with an ADM will confer its putative advantages including an extra-layer of implant protection and support in the lower pole.