Medico-legal Expert​​ 

Dermal Sling- Skin Reducing Mastectomy and immediate reconstruction using expander/ Implant Technique.

The lower-pole mastectomy skin flap is de-epithelialized- a process removing the superficial layer of skin only. This leaves the deep dermal layer intact.
Mastectomy flaps are raised, as in a standard mastectomy. The inframammary fold is preserved . 
The Pectoralis Major muscle ( ARM muscle on the chest wall ) is  released (elevated) from the underlying ribs and a submuscular pocket created.
The Expander/implant is placed into the submuscular pocket after filling it to the desired level, avoiding excessive tension on the submuscular pocket or the skin flap.
The de-epithelialized lower mastectomy flap is then sutured to the lower border of pectoralis major with interrupted sutures to provide a complete soft tissue cover for the expander. 
The horizontal and vertical skin incisions are then closed creating a verticle scar and horizontal scar (Inverted T).


1. Dietz J., Lundgren P., Veeramani A., et al. Autologous inferior dermal sling (autoderm) with concomitant skin-envelope reduction mastectomy: an excellent surgical choice for women with macromastia and clinically significant ptosis. Annals of Surgical Oncology. 2012;19(10):3282–3288. doi: 10.1245/s10434-012-2549-2.[PubMed] [Cross Ref]

2. Irwin G. W., Black A., Refsum S. E., McIntosh S. A. Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: a safe and effective technique in risk-reducing and therapeutic mastectomy. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2013;66(9):1188–1194. doi: 10.1016/j.bjps.2013.04.048. [PubMed] [Cross Ref]

3. Rusby J. E., Smith B. L., Gui G. P. H. Nipple-sparing mastectomy. British Journal of Surgery. 2010;97(3):305–316. doi: 10.1002/bjs.6970. [PubMed] [Cross Ref]

4. De La Cruz L., Moody A. M., Tappy E. E., Blankenship S. A., Hecht E. M. Overall survival, disease-free survival, local recurrence, and nipple–areolar recurrence in the setting of nipple-sparing mastectomy: a meta-analysis and systematic review. Annals of Surgical Oncology. 2015;22(10):3241–3249. doi: 10.1245/s10434-015-4739-1. [PubMed] [Cross Ref]

5. King I. C. C., Harvey J. R., Bhaskar P. One-stage breast reconstruction using the inferior dermal flap, implant, and free nipple graft. Aesthetic Plastic Surgery. 2014;38(2):358–364. doi: 10.1007/s00266-014-0276-8. [PubMed] [Cross Ref]

Skin-sparing mastectomy was introduced into clinical practice several years ago and is now considered an oncologically safe surgical procedure.

Saving the skin envelope and inframammary fold (The crease under your breast)  improves the reconstructive outcome of a conventional radical modified or simple mastectomy and avoids unpleasant scarring.

Stages of the operation are shown below:- The Technique is similar to a Breast Reduction using a Inverted T incision.(WISE PatternType your paragraph here.