Immediate prosthetic breast reconstruction: the ensured subpectoral pocket (ESP)

Implant exposure due to cutaneous necrosis is one of the most feared complications of mastectomy with immediate prosthetic reconstruction. A key issue is to ensure good blood supply to the skin and complete integrity of the submuscular pocket. The latter is created with the pectoralis major and supplemented with the serratus anterior, the rectus abdominis sheat, the obliquus mayor and the pectoralis minor. The main drawback is that those muscles, when sutured to create a complete pocket, only allow the setting of small-sized implants. The authors present the application of polyglycolic mesh in an original fashion, mimicking the anatomy of the muscles usually employed in pocket creation. The proposed technique has been denominated Ensured Subpectoral Pocket and has proved to be a valid strategy in immediate single stage prosthetic breast reconstruction. It allows the setting of bigger implants without previous tissue expansion while preventing implant displacement. In addition, it reduces emotional trauma on patients and lowers surgical costs.