Immediate Bilateral Breast Reconstruction With Implants and Inferolateral AlloDerm Slings

In Brief To shorten the reconstructive process, improve results, and provide additional options for women seeking mastectomy, we used an acellular cryopreserved dermal matrix (AlloDerm) sling to reestablish the lower pole of the pectoralis major muscle. This technique creates a subpectoral–sub-AlloDerm pocket that completely encloses the breast implant. By tailoring the width of the AlloDerm, we can precisely control the degree of lower-pole fullness. This technique shortens or eliminates the need for tissue expansion and provides an additional option for single-stage breast reconstruction with implants. We have selectively used this technique as a reconstructive option for 10 women undergoing bilateral mastectomy (20 breasts). Twenty women undergoing bilateral skin-sparing mastectomies were immediately reconstructed by creating slings of AlloDerm between the inferior margin of the pectoralis major and the chest wall at the inframammary fold. This permitted primary submuscular placement of full-size implants without the intermediate step of tissue expander placement.