Skin-Reducing Mastectomy and Direct-to-Implant Breast Reconstruction Without Mesh: A Single-Institute Experience

Performing breast reconstruction in large and ptotic breasts remains technically challenging, with a high incidence of postoperative complications and unsatisfactory cosmetic results. Skin-reducing mastectomy (SRM) was introduced for breast reconstruction for females with macromastia. In this study, we report the experience in Alexandria Main University Hospital (AMUH), Alexandria, Egypt, with SRM and direct-to-implant (DTI) breast reconstruction without the utilization of biological or synthetic meshes.

A prospective study was carried out at AMUH from October 2020 to October 2022. It included 20 female patients having large and ptotic breasts who were indicated for mastectomy, with the exclusion of non-motivated patients, inflammatory breast cancer, significant clinical comorbidities, and patients indicated for postoperative radiotherapy. All the operations were done as a single stage in which the SRM was performed through a Wise-pattern skin incision, along with the creation of a dermal sling to cover the implant.

A total of 20 surgeries were performed, in which the implant was placed in a pre-pectoral position in 10 cases. In the other 10 cases, the implant was inserted partially subpectoral by creating a musculo-dermal pouch to envelop the implant. The most prevalent complication encountered was delayed wound healing at the area of the inverted T-junction. None of the studied patients experienced wound infection, capsular contracture, or implant loss.

SRM and DTI breast reconstruction is a feasible technique that can be safely used in patients with large and ptotic breasts. The inferior dermal sling allows for a single-stage implant-based breast reconstruction without the utilization of biological or synthetic meshes.