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

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncology

Background:

• Breast reconstruction for macromastia presents challenges, including high complication rates and poor cosmetic outcomes.
• Skin-reducing mastectomy (SRM) offers a solution for breast reconstruction in patients with large and ptotic breasts.
• This study evaluates the efficacy of SRM combined with direct-to-implant (DTI) reconstruction without mesh use.

Purpose of the Study:

• To assess the feasibility and safety of single-stage SRM and DTI breast reconstruction in patients with large and ptotic breasts.
• To report outcomes from Alexandria Main University Hospital (AMUH) using this technique without biological or synthetic meshes.

Main Methods:

• A prospective study included 20 female patients with large, ptotic breasts undergoing mastectomy between October 2020 and October 2022.
• SRM was performed using a Wise-pattern incision, creating a dermal sling to cover the implant in a single stage.
• Implants were placed pre-pectorally (10 cases) or partially subpectorally (10 cases).

Main Results:

• Twenty SRM and DTI breast reconstructions were successfully performed.
• The most common complication was delayed wound healing at the inverted T-junction.
• No cases of wound infection, capsular contracture, or implant loss were observed.

Conclusions:

• SRM and DTI breast reconstruction is a viable and safe single-stage option for patients with large and ptotic breasts.
• The technique, utilizing an inferior dermal sling, eliminates the need for mesh augmentation.
• This approach provides a satisfactory alternative for breast reconstruction without mesh.