Dermal Flap Based Breast Reconstruction

Abstract

Autologous dermal flap (DF) with an implant is a well-recognized technique of immediate breast reconstruction (IBR) in large and ptotic breasts where skin reduction is necessary. The procedure uses de-epithelialised lower pole skin flap as a hammock to support and cover the lower pole of the implant. This potentially decreases the problems associated with biological meshes and reduces the capsular contracture rates. Good patient selection is the key to a satisfactory outcome from DF based breast reconstruction because the technique relies on adequate skin in the lower pole of the breast to be used as a dermal flap (DF); also referred to as dermal sling. The technique leads to a reconstructed breast of a significantly reduced volume and hence it is also important to ensure that the patient understands the potential need for contralateral symmetrization reduction. Patient should also be counselled on all the other implant related issues too prior to this surgery. As such, careful patient selection and adherence to the principles of an implant based reconstruction are the keys to a satisfactory outcome. The technique is known to provide good oncological and aesthetic outcomes. This chapter outlines the principles of DF and implant based immediate breast reconstruction.