Background: Increasing awareness of post- mastectomy
reconstruction raises the demand of searching of many alternatives
that can be applied to every patient who came for
reconstruction. Completion of expander pocket in first-stage
of delayed-immediate breast reconstruction was performed
by many techniques.
Aim: We propose an algorithm for this step that can be
applied in our low-income country.
Methods: Thirty-four patients fulfilling skin-sparing
mastectomy criteria were enrolled in this study. Definite
decision regarding postoperative radiotherapy was questionable.
First stage of delayed-immediate reconstruction performed
with insertion of expander at time of mastectomy.
Regarding choice of completion of sub-muscular pocket of
expander, the patients were divided into two groups according
to the degree of ptosis: Group I (large ptotic breasts where in
dermal flap was indicated), group II (small non ptotic breasts
wherein total submuscular pocket indicated).
Results: Dermal flap was performed on patients with large
ptotic breasts, whereas subpectoral pocket completion was
performed on patients with small non-ptotic breasts using the
serratus fascia. Two algorithms were proposed to guide the
surgeon during the selection of timing and the second one in
choosing the most suitable technique. Early post-operative
complications where minor and managed conservatively.
Conclusion: Decisions regarding postmastectomy breast
reconstruction are multifactorial. The factors not only include
staging and perioperative adjuvant management but also
include considerations regarding cost and availability of
resources. Authors proposed an economically directed algorithm
in the first stage of delayed-immediate reconstruction
for selection of expander coverage.