Submuscular breast reconstruction: a one-stage method of tissue expansion.

This article discusses the use of a permanent saline-filled expander for breast reconstruction incorporating on the anterior surface a filler valve that can be located by nonoperative means. The self-sealing filler valve has a well-marked design that is particularly amenable to ultrasound detection. This results in the capacity to inflate or deflate the prosthesis at will. Sixty patients were operated on and 123 submuscular custom-made prosthetic expanders were implanted. Seventy-four percutaneous volumetric changes were performed without significant complications. Follow-up studies for more than 6 years are presented. The primary advantage of this prosthesis is its capability for percutaneous access under local anesthetic to produce volumetric changes. The prosthesis is permanent and does not have to be replaced as normal tissue expanders do. Only 1 operation is necessary. In addition, capsule contracture and spontaneous deflation rates are within an acceptable range.

The reversed dermis flap.

The reversed dermis principle of Hynes has been applied to flaps. There are 2 main varieties: the direct bridge pedicle flap and the turn-over local flap but the same principle might occasionally be useful in free flaps.