{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T22:33:24Z","timestamp":1772058804676,"version":"3.50.1"},"reference-count":25,"publisher":"Royal College of Surgeons of England","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> Patients with large ptotic breasts undergoing immediate implant-based reconstruction often require skin-reducing mastectomy to optimise the aesthetic outcome. However, healing complications, especially at the resulting inverted T-junction, leading to wound dehiscence, infection, skin necrosis, implant exposure and failed reconstruction have been widely reported. We present an innovative approach for immediate implant-based reconstruction combining porcine- or bovine-derived acellular dermal matrices with a de-epithelialised dermal sling to protect and support the implant, while improving clinical outcomes in this challenging group of patients. <\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p> Demographic, tumour and surgical data were reviewed for patients undergoing Wise pattern (T-scar) skin-reducing mastectomies with immediate implant-based reconstruction combining porcine- or bovine-derived acellular dermal matrices with a de-epithelialised dermal sling. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> This technique was successfully employed to reconstruct five large pendulous breasts in four breast cancer patients with a median age of 50.5 years (range 34\u201361 years) who were not suitable for, or had declined, flap-based reconstruction. The acellular dermal matrices used were SurgiMend\u00ae, Strattice<jats:sup>TM<\/jats:sup> and Braxon\u00ae and the expandable implants were placed in the sub-pectoral (n = 3) and pre-pectoral (n = 1) planes. The technical steps and clinical outcomes are presented. One patient experienced T-junction breakdown overlying the de-epithelialised dermis without implant loss. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> The combination of an acellular dermal matrix and a dermal sling provides a double-layer \u2018water-proofing\u2019 and support for the implants inferiorly, avoiding T-junction breakdown complications, since any dehiscence is on to well-vascularised dermis. Furthermore, the acellular dermal matrix stabilises the implant in the large mastectomy cavity (pocket control). This approach provides a viable option which facilitates mastectomy and immediate implant reconstruction in large-breasted patients. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2018.0127","type":"journal-article","created":{"date-parts":[[2018,8,16]],"date-time":"2018-08-16T11:38:47Z","timestamp":1534419527000},"page":"e197-e202","source":"Crossref","is-referenced-by-count":12,"title":["Combination of acellular dermal matrix with a de-epithelialised dermal flap during skin-reducing mastectomy and immediate breast reconstruction"],"prefix":"10.1308","volume":"100","author":[{"given":"HKN","family":"Kankam","sequence":"first","affiliation":[{"name":"University of Cambridge School of Clinical Medicine, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"GJM","family":"Hourston","sequence":"additional","affiliation":[{"name":"University of Cambridge School of Clinical Medicine, Cambridge, 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