Dermo-Glandular Suspension Following Wise-Pattern Explantation-Mastopexy: Is it Reaching the Intended Heights?

The inferiorly based dermo-glandular sling is well described for implant coverage in post-mastectomy prosthetic reconstruction and attempted restoration of upper pole fullness in (therapeutic and aesthetic) mammaplasty procedures, to variable long-term effect. We reviewed the technique modifications by a single surgeon, over 13 years, and the aesthetic outcomes achieved, when used in the context of cosmetic breast implant removal.

Breast explant patients with a Wise-pattern skin incision by a single surgeon between 2011 and 2024 were identified.

implant exchange, explantation only and LeJour pattern breast lift. Demographics and perioperative data were recorded. Perioperative photographs were assessed using the established Breast Cancer Conservation Treatment. Cosmetic Results (BCCT.core) software to analyse the aesthetic result.

19 patients underwent implant removal and parenchymal re-draping with an inferiorly based dermo-glandular sling. Patients were: perimenopausal women (mean=54yrs) with raised BMI (mean=27.6kg/m²). Indications (overlapping) for explantation included: disharmony between implant and breast envelope (10/19; 52.6%), discomfort/ pain (8/19; 42.1%), concerns about BIA-ALCL (5/19; 26.3%) and symptoms of "breast implant illness" (6/19; 31.6%). Others claimed their augmented breasts were simply too large (9/19; 47.4%). Bra size decreased from pre-explant size of 36E to 36C (median). Post-operative photographs were available for 18/19 patients. BCCT.core ratings were wholly favourable, with five rated Excellent and the remainder rated as Good.

An inferior, de-epithelialised dermo-glandular sling can reliably rejuvenate the female breast following breast implant removal, where there is disharmony between parenchymal volume, distribution and envelope. We illustrate a reliable technique that achieves objectively good to excellent aesthetic results, with long-term efficacy. (249 words) Most common presentations for seeking explantation in our cohort were concerns about the degree of ptosis, pain, anxiety about BIA-ALCL and symptoms of breast implant illness. This technique offers a reliable and aesthetically robust option to restore some volume and uplift and reshape the explanted breast, in patients declining re-implantation or staged surgeries. Suitable patients as determined by our cohort are middle-aged women with large, previously augmented breasts (~330cc mean, 36E median), with an above-average BMI (27.6) yielding suitable inferior pole tissue for suspension.

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