title: The suspension technique to avoid the use of tissue expanders in breast reconstruction.
abstract: BACKGROUND
  Immediate or delayed breast reconstruction is usually performed using expansion techniques or pedicled or free flaps. The suspension technique hereby described can reduce the number of surgical stages, as well as donor-site sequelae.
  
  
  METHODS
  The authors describe a new technique of breast reconstruction with implants using a nonabsorbable mesh to create a superior abdominal cutaneous flap, which contributes to the skin envelope of the reconstructed breast. The advantage of this technique is the opportunity to use immediately a definitive prosthesis also in cases requiring a mastectomy with the resection of a large amount of skin, consequently reducing the indications of tissue expanders or myocutaneous flaps.
  
  
  RESULTS
  We performed the "suspension technique" in 67 cases of immediate reconstruction and in 6 cases of delayed reconstruction. No further surgery under general anesthesia was necessary in 56 patients (76.7%). In 14 cases (19.2%), a second operation under general anesthesia was necessary for implant replacement, capsula revision, and nipple and areola (NAC) reconstruction. In 3 cases (4.1%), implant removal was necessary due to implant exposition or infection. In 33 patients, only NAC reconstruction was performed under local anesthesia. In our series, capsula contracture was graded as Baker I in 24 cases, grade II in 16 cases, grade III in 9 cases, and grade IV in 1 case. Breast symmetry, patient's satisfaction, and surgeon cosmetic evaluation were respectively scored 7.56, 7.75, and 7.60 (range from 1 to 10).
  
  
  CONCLUSIONS
  In conclusion, this technique can be applied in cases requiring a large skin resection at the time of mastectomy and refusing a reconstruction with myocutaneous flaps or a second surgery, necessary if a reconstruction with tissue expanders is planned.
authors.affiliation: Plastic and Reconstructive Surgery Department, European Institute of Oncology, 20141 Milan, Italy. mario.rietjens@ieo.it
authors.forename: Mario
authors.initials: M
authors.lastname: Rietjens
authors.forename: Francesca
authors.initials: F
authors.lastname: De Lorenzi
authors.forename: Marco
authors.initials: M
authors.lastname: Venturino
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Petit
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D018427:Breast Implants; D003286:Contracture / Q000209:etiology; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000534:rehabilitation; D008875:Middle Aged; D009558:Nipples / Q000601:surgery; D017060:Patient Satisfaction; D012086:Reoperation; D013526:Surgical Mesh; D015625:Tissue Expansion Devices