Combining muscle-sparing serratus flap with acellular dermal matrix in immediate breast reconstruction

Background: Submuscular placement of tissue expanders is a common method of reconstruction in the postmastectomy patient. Though the pectoralis muscle provides ample coverage of the expander superomedially, it is insufficient for complete coverage. Inferior coverage has been described using both local muscle and fascial flaps as well as the more recently introduced acellular dermal matrix (ADM). Each method possesses advantages and disadvantages, while the use of both in conjunction may serve to provide a superior, cost-effective result. Methods: A retrospective review was undertaken of all patients undergoing immediate breast reconstruction from January 2008 to December 2011. Patients who underwent reconstruction with the use of combined ADM and muscle-sparing serratus flap were selected for further review. A total of 16 patients (27 reconstructed breasts) were identified. Data were collected regarding patient demographics, operative details, and complications. Results: Of the 16 patients, 6 received postoperative radiation and 9 received perioperative chemotherapy. Mean follow-up was 20.8 months. A single 8 × 16-cm sheet of ADM was sufficient for bilateral reconstruction. Complications included infection (three patients), mastectomy flap necrosis (two patients), expander exposure (one patient), wound dehiscence (one patient), hematoma (one patient), and seroma (one patient). There were no cases of capsular contracture. All patients were noted to have sufficient lateral fullness and optimal contour. Conclusions: Combined use of a muscle-sparing serratus anterior flap with ADM is a safe and viable method of complete inferior expander coverage in immediate breast reconstruction, which has not yet been described in the literature. Potential advantages include decreased donor site morbidity, improved lateral fullness, and greater efficiency in ADM use. Level of Evidence: Level IV, therapeutic study.