The "dermal cage": Inferiorly based dermal flap technique for breast reconstruction after mastectomy

"Direct to implant," "one-stage," or "immediate" breast reconstruction procedures have become extremely popular in the last decade. The additional task of covering the lower pole of the prosthetic implant for stability can be achieved by one of two principal methods: either the use of acellular dermal matrix (ADM) or alternatively by the use of autologous dermis (inferiorly based dermal flap). In 2013, we published a modification of the inferior pedicle technique for reduction mammaplasty with the principal goal of making a strong, durable, and internalized ``dermal cage'' fixed to the chest wall to support the remaining breast tissue and to prevent the long-term descent of the breast tissue through the effects of gravity. At that time, we started to use the same technique in breast reconstruction for selected cases who required skin or nipple-sparing mastectomy with reduction of the skin envelope, not just to cover the lateroinferior pole of breast implants as an alternative to ADM but primarily for functional support and suspension with fixation of the implant on the chest wall, shaping the reconstructed breast with the aim of preventing lateral displacement. In this article, we present the method and rationale of our "dermal cage" technique explaining differences between previously published modifications by other authors of the inferior dermal pedicle.