Research Article| Volume 65, ISSUE 9, P1204-1208, September 2012

One stage breast reconstruction following prophylactic mastectomy for ptotic breasts: The inferior dermal flap and implant



      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lalloo F.
        • Baildam A.
        • Brain A.
        • Hopwood P.
        • Evans D.G.
        • Howell A.
        A protocol for preventative mastectomy in women with an increased lifetime risk of breast cancer.
        Eur J Surg Oncol. 2000; 26: 711-713
        • Hopwood P.
        • Lee A.
        • Shenton A.
        • et al.
        Clinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes.
        Psychooncology. 2000; 9: 462-472
        • Evans D.G.
        • Baildam A.D.
        • Anderson E.
        • et al.
        Risk reducing mastectomy: outcomes in 10 European centres.
        J Med Genet. 2009; 46: 254-258
        • Evans D.G.
        • Lalloo F.
        • Hopwood P.
        • et al.
        Surgical decisions made by 158 women with hereditary breast cancer aged <50 years.
        Eur J Surg Oncol. 2005; 31: 1112-1118
        • McIntosh A.
        • Shaw C.
        • Evans G.
        • et al.
        Clinical guidelines and evidence review for the classification and care of women at risk of familial breast cancer. NICE guideline CG041.
        National Collaborating Center for Primary Care/University of Sheffield, London2004 (Available from:) ([updated 2006])
        • Gopie J.P.
        • Hilhorst M.T.
        • Kleijne A.
        • et al.
        Women's motives to opt for either implant or DIEP-flap breast reconstruction can be of great importance in the decision-making process.
        J Plast Reconstr Aesthet Surg. 2011 Apr 20; ([Epub ahead of print])
        • Cordeiro P.G.
        • McCarthy C.M.
        A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications.
        Plast Reconstr Surg. 2006; 118: 825-831
        • Cordeiro P.G.
        • McCarthy C.M.
        A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: part II. An analysis of long-term complications, aesthetic outcomes, and patient satisfaction.
        Plast Reconstr Surg. 2006; 118: 832-839
        • Salzberg C.A.
        • Ashikari A.Y.
        • Koch R.M.
        • Chabner-Thompson E.
        An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm).
        Plast Reconstr Surg. 2011; 127: 514-524
        • Birnbaum L.
        Use of dermal grafts to cover implants in breast reconstructions.
        Plast Reconstr Surg. 1979 Apr; 63: 487-491
        • Bayram Y.
        • Kulahci Y.
        • Irgil C.
        • Calikapan M.
        • Noyan N.
        Skin-reducing subcutaneous mastectomy using a dermal barrier flap and immediate breast reconstruction with an implant: a new surgical design for reconstruction of early-stage breast cancer.
        Aesthetic Plast Surg. 2010; 34: 71-77

      Linked Article

      • Reduction-pattern mastectomy: Vascularity of the inferior dermal flap
        Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 66Issue 4
        • Preview
          The 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.
        • Full-Text
        • PDF