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A Simplified Technique for Single Stage Breast Reconstruction
William G Austen, Jr., Tristan L Hartzell, Mary Catherine Hertl
Massachusetts General Hospital, Boston, MA
Objective: To describe an alternative method for immediate breast reconstruction that is cost-effective and safe.
Design: Retrospective record review
Setting: Tertiary academic medical center
Patients: Twenty-five patients undergoing mastectomies were treated with immediate implant reconstruction using Alloderm and serratus muscle elevation. Mean patient age was 47 years with average follow-up of 10 months. Ten patients underwent bilateral reconstruction immediately. Of the 35 implants placed, 15 were saline and 20 were silicone. The average implant size was 385 cc.
Interventions: After development of a subpectoral pocket the serratus muscle was elevated. AlloDerm was then sutured in place to create a space for immediate reconstruction.
Main outcome measures: The number of patients able to undergo immediate reconstruction with one sheet of AlloDerm and their complications.
Results: Thirty of the 35 breasts were reconstructed with the assistance of only a single sheet of AlloDerm. In these cases a single 4x16 or 4x12 inch sheet was used. Three breasts required revision secondary to areas of mastectomy flap necrosis. Two were revised in an office setting. One patient required operating room revision after implant extrusion. Two implants were exchanged for asymmetry and wrinkling, respectively.
Conclusions: Recently, AlloDerm has been suggested as a tool for immediate implant reconstruction. Current methods involve the use of 2 or more sheets of AlloDerm. We describe a safe, simple, and cost effective technique in which the serratus muscle is raised off the chest wall and one sheet of AlloDerm is used. In our opinion, the lateral view of the breast is also improved by this alternative operation.
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