One-stage breast reconstruction using the inferior dermal flap, implant, and free nipple graft.
BACKGROUND
An inferior dermal flap with implant is a useful option for women hoping for immediate breast reconstruction. This one-stage procedure uses autologous tissue as an inferolateral local sling, avoiding the costs and potential morbidity of prosthetic mesh and reducing valuable operating time. Patient comorbidity or choice may restrict autologous reconstruction options available. Many patients will still require a second procedure for subsequent nipple reconstruction and further appointments and costs for tattooing.


METHODS
A prospective database was kept of a single surgeon's experience with 16 patients (19 breasts) from 2010 to 2012. Reconstruction was performed following a Wise pattern skin incision. An inferior, deepithelialized dermal sling was sutured to the pectoralis major to form a pocket for a silicone implant or tissue expander. A free nipple graft was sited at the time of reconstruction, with biopsies taken from retroareolar tissue.


RESULTS
Patient average age was 54 years (range 36-66). Six mastectomies were for ductal carcinoma in situ, 6 for invasive carcinoma, 2 for lobular carcinoma, and 5 of 19 mastectomies were prophylactic. Average operative time was 165 min. There were no immediate complications requiring reoperation. All retroareolar biopsies were benign and no locoregional recurrences have occurred. Two nipples had partial necrosis of the lower pole but healed with conservative treatment. No patients required any subsequent procedures to their reconstructed breast.


CONCLUSIONS
The inferior dermal flap with implant and free nipple graft is an excellent single-stage reconstruction option. This method offers a potentially safe, reliable, and aesthetically acceptable outcome for women with larger, ptotic breasts.


METHODS
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Department of General Surgery, University Hospital of North Tees, Stockton-on-Tees, Cleveland, TS19 8PE, UK, ianccking@doctors.org.uk.
I C C
IC
King
J R
JR
Harvey
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Bhaskar
D000328:Adult; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D016208:Databases, Factual; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D011446:Prospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology