One Stage Immediate Implant-Based Breast Reconstruction with a Dermal Flap and Nipple Reconstruction

Abstract

The dermal flap and implant technique in conjunction with Wise pattern mastectomy flaps is suitable for immediate reconstruction in patients with moderate or large breasts. The inferiorly based dermal flap controls the implant pocket, improves soft tissue cover and protects the implant from wound closure complications. The autologous flap is more cost-effective than an Acellular Dermal Matrix and is less prone to complications such as seromas and implant infections. The technique is versatile and can be used following both prophylactic and therapeutic mastectomies and either a definitive implant or an expander can be placed depending on size of the created envelope, vascularity of the mastectomy skin flaps and the breast volume desired by the patient. Furthermore, a nipple can be created using tissue at the apex of the vertical scar which is normally discarded in a wise pattern closure. Alternatively, if the nipple areolar complex is to be preserved, it can be maintained on a dermal pedicle or on the dermal flap itself. Overall, it is a versatile technique that is allows single stage immediate reconstruction in patients with moderate or large breasts that are not suitable for or do not wish to have complex autologous reconstruction.