Application of Titanium-Coated Polypropylene Mesh (TiLOOP Bra) Combined with a De-Epithelialized Dermal Flap During Skin-Reducing Mastectomy (SRM) for Immediate Implant-Based Breast Reconstruction (IBR) in Chinese Patients.

Abstract

<h4>Background</h4>This study revisits previously described skin-reducing mastectomy and dermal flap-muscle pocket techniques for immediate breast reconstruction in large, drooping breasts. Compared to techniques previously described in the literature, combining TiLOOP Bra improved the quality of implant coverage, enhanced the esthetic outcome, and allowed for the use of larger implant volumes. Subjects and Methods The study was conducted at three centers in China. It included patients with large sagging breasts with a bra cup size D or larger. Patients had an areola-to-inframammary fold distance of 8 cm or greater and a nipple-to-sternal notch distance of 25 cm or greater. The implant was supported by suturing the TiLOOP Bra to the free lower pectoral margin and the inframammary fold while covering the implant with a de-epithelialized inferior or medial dermal flap.<h4>Results</h4>A total of 25 patients were included, with an average age of 43.8 years (range, 26 to 58 years). The average body mass index was 27.8 (range, 23.8 to 34.2). Unilateral reconstruction was carried out in 21 patients (84%), while bilateral reconstruction was performed in 4 patients (16%). The average implant volume was 355 cc (range, 270 to 480). Symmetrical breast reduction was performed simultaneously on 18 patients (72%). The average follow-up period was 52 weeks. Only 4 minor breast complication was noted. No implants were removed. The cosmetic outcome was good (Harvard score: mean 3.4, range 1-4; SD 0,5).<h4>Conclusion</h4>The technique of TiLOOP Bra combined with a dermal flap in the immediate reconstruction of large, drooping breasts is safe and versatile. It can also create natural-looking breasts with larger implants. This technique was performed on 25 patients. We presented an innovative approach for immediate breast reconstruction combining a TiLOOP Bra with a de-epithelialized skin flap (dermal sling). All patients had esthetically pleasing results. These preliminary results need to be confirmed by long-term and comparative studies.<h4>Level of evidence iv</h4>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .