Background: In 2004, we reported on our findings with placement of tissue expanders for breast reconstruction in the partial submuscular position – the equivalent of the “dual plane” technique for breast augmentation. Limitations with subpectoral expander placement include difficulty controlling the lower pole of the pocket during expansion, tenuous device coverage by a thin inferior mastectomy flap, effacement of the inframammary fold, and superior displacement of the pectoralis major muscle. To address these concerns, we examined the safety and efficacy of an acellular dermal sling to provide inferolateral support to the device during expansion.

Methods: We prospectively studied 43 consecutive women representing 58 breasts who underwent immediate reconstruction with tissue expanders and acellular dermis between March 2004 and June 2005. Following completion of adjuvant therapy and expansion, devices were exchanged to implants. We followed this cohort through January, 2007 and recorded demographics, operative courses, complications, and aesthetic outcomes.

Results: Mean time to complete reconstruction was 8.6 months. Mean follow-up was 25.9 months after stage I and 18.1 months after stage II. Perioperative complication rate after expander/acellular dermis placement was 12%, and correlated strongly with adjuvant radiation. Complication rate after exchange to implants was 2%, and overall revision rate was 4%. The aesthetic score of reconstructed breasts did not differ significantly from unoperated controls.

Conclusions: Acellular dermis appears to be a valuable adjunct in immediate prosthetic breast reconstruction. Acellular dermis assisted breast reconstruction has an acceptably low complication rate, yields aesthetic outcomes, and affords an expeditious, predictable reconstruction.