Extended dermal sling for implant-based immediate prepectoral breast reconstruction in large ptotic breasts without using a mesh in early breast cancer

Background
The rate of immediate breast reconstruction after mastectomy for early breast cancer has recently increased owing to the technological advancements in tissue expanders and implant designs, acellular dermal matrices, and fat grafting. The use of an extended dermal sling to cover the implant in patients with large ptotic breast allows prepectoral breast reconstruction, avoiding the complications and pitfalls of pectoralis muscle elevation and evading the use of the acellular dermal matrices with its high cost and being a foreign material.
Patients and methods
A total of 22 patients underwent mastectomy through a Wise pattern incision. The de-epithelialized extended dermal sling was used to create a prepectoral pocket for the implant and sutured to the pectoralis fascia.
Results
The median BMI was 31.5 kg/m (range, 28–39). The median distance between the areola and the inframammary fold was 20.3 cm (range, 18–26). A total of 13 patients had permanent implant and nipple graft, whereas nine patients had a tissue expander. The average implant size was 375 ml (range, 325–450). Three patients developed seroma around the implant. One patient had mild erythema and two patients had delayed wound healing. Two patients developed partial nipple necrosis. One patient experienced infection and wound dehiscence mainly at the T-junction, and the vertical limb, which was managed by a re-do surgery, removal of the implant, and insertion of a tissue expander. The average follow-up was 14 months (range, 8–24).
Conclusion
Extended dermal sling is a safe, reliable, and effective option for immediate prepectoral breast reconstruction after mastectomy for patients with early breast cancer who have a large ptotic breast. It has a great advantage of being an autologous tissue with minimal complications and good esthetic results.