Breast reconstruction using implants remains an aesthetic challenge toward achieving symmetry and natural appearance. Closing the areolar defect results in a vertically elevated breast mound. The use of human acellular dermal tissue matrix has been reported to provide coverage and durability over breast implants while allowing for improved shape of the reconstructed breast. This study reports the operative technique used in a series of breast reconstructions using saline implants and human acellular dermal tissue matrix in an immediate one-stage procedure. Complications and appearance were evaluated for all reconstructions. Indications for inframammary fold reconstruction and lower pole breast enhancement using chest skin advancement were discussed. Twenty-three patients were included in the study; 11 had unilateral reconstruction and 12 had bilateral reconstruction for 35 total reconstructions. All patients had immediate reconstruction following skin-sparing mastectomy. Nine patients had inframammary fold reconstruction and 11 patients had a lower chest advancement flap with fold reconstruction. The mean follow-up was 9.5 months with a range of 1 to 24 months. Complications occurred in 3 patients. Human acellular dermal tissue matrix can successfully be used in conjunction with breast implants to achieve an aesthetically pleasing breast reconstruction in one stage at the time of skin-sparing mastectomy. The use of a tissue expander and its associated risks and costs are eliminated. The complication rate is low. In addition, either inframammary fold reconstruction or lower chest advancement and fold reconstruction to augment lower pole skin coverage can improve symmetry with the opposite breast.

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Summary:Removal of an intact, inflated tissue expander can result in uncontrolled spillage of expander contents on the drapes, surgeons, staff, or patient. The technique described has been used for the past 4 years to eliminate these spillage concerns. It is simple and inexpensive using common disposable supplies found in any operating room. An irrigating syringe is modified by cutting away its 2 flanges. The bulb is removed and suction is applied to the syringe tip. The expander is punctured with a scalpel while the puncture hole is covered by the syringe opening. The applied suction aspirates the contents thereby deflating the expander. Uncontrolled content spillage and spray are eliminated.