The Use of Serratus Anterior Fascial Flap in Integrated Mastectomy and Implant Reconstruction

  • Yolanda Ho-Yan Chan
  • Ivan Kai-Hong Yue
  • Chiu-Ming Ho
  • Polly Suk-Yee CheungEmail author
Original Scientific Report



Tissue reinforcement with acellular dermal matrix (ADM) in implant-based breast reconstruction contributes to the coverage of the implant and avoids its direct exposure to skin incision, yet not without risk of infection. Our integrated technique makes use of the in situ serratus anterior fascia as a support of the implant following mastectomy, which serves the same purpose of ADM in terms of aesthetic outcomes, but minimizes the hazard of infective complications.


We retrospectively reviewed all the nipple-sparing mastectomies with direct-to-implant immediate reconstruction in Hong Kong Sanatorium and Hospital from 2012 to 2016. The authors made use of the serratus anterior fascial flap as inferolateral coverage for the subpectoral implant. Consequently, the implant would be completely covered by autologous tissues.


Among the 51 women included, primary breast cancers account for 91.8% of our indications for these 61 procedures of integrated mastectomy and implant reconstruction. The remaining five (8.2%) were performed as contralateral prophylactic mastectomy. Almost three quarters of the patients had a bra cup size of B or below. After a mean follow-up of 28.9 months, there was no reported post-operative complication of skin flap or nipple–areolar complex necrosis, or infection or extrusion of the implant.


Our series support that the serratus anterior fascial flap could provide autologous coverage in integrated mastectomy and implant breast reconstruction, especially in small- and medium-sized breasts. Appropriate patient selection, as well as meticulous surgical technique, is critical for its success.




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Yolanda Ho-Yan Chan
    • 1
  • Ivan Kai-Hong Yue
    • 1
  • Chiu-Ming Ho
    • 2
  • Polly Suk-Yee Cheung
    • 3
    Email author
  1. 1.Department of SurgeryKwong Wah HospitalKowloonHong Kong SAR
  2. 2.Plastic and Reconstructive Surgery CentreHong Kong Sanatorium and HospitalHappy ValleyHong Kong SAR
  3. 3.Breast Care CentreHong Kong Sanatorium and HospitalHappy ValleyHong Kong SAR

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