Local Autologous Tissues for Expander Coverage in 1st Stage of Delayed-Immediate Breast Reconstruction: Economy-Directed Protocol Modification

Abstract

Background: Increasing awareness of post-mastectomy reconstruction raises the demand of searching of many alternatives that can be applied to every patient who came for reconstruction. Completion of expander pocket in first-stage of delayed-immediate breast reconstruction was performed by many techniques. Aim:We propose an algorithm for this step that can be applied in our low-income country.Methods: Thirty-four patients fulfilling skin-sparing mastectomy criteria were enrolled in this study. Definite decision regarding postoperative radiotherapy was questionable. First stage of delayed-immediate reconstruction performed with insertion of expander at time of mastectomy. Regarding choice of completion of sub-muscular pocket of expander, the patients were divided into two groups according to the degree of ptosis: Group I (large ptotic breasts where in dermal flap was indicated), group II (small non ptotic breasts wherein total submuscular pocket indicated).Results: Dermal flap was performed on patients with large ptotic breasts, whereas subpectoral pocket completion was performed on patients with small non-ptotic breasts using the serratus fascia. Two algorithms were proposed to guide the surgeon during the selection of timing and the second one in choosing the most suitable technique. Early post-operative complications where minor and managed conservatively. Conclusion:Decisions regarding postmastectomy breast reconstruction are multifactorial. The factors not only include staging and perioperative adjuvant management but also include considerations regarding cost and availability of resources. Authors proposed an economically directed algorithm in the first stage of delayed-immediate reconstruction for selection of expander coverage.