Immediate Breast Reconstruction with Composite Reverse Inferior Muscle Sling – a hybrid technique

Summary Background: Prepectoral implant-based reconstruction is often utilized as an alternative to submuscular placement in the surgical management of breast cancer. However, this technique can lead to caudal displacement of the implant along the thoracic wall. This study aims to evaluate the safety and patient satisfaction of using an inferior muscle sling from the pectoralis major muscle to stabilize the implant, compared to a control group without the muscle sling. Methods: In this single-center retrospective study, we included patients who underwent prepectoral breast reconstruction with an inferior muscle sling between October 2020 and December 2022. Patients were matched 1:1 with a control group who received prepectoral implant-based reconstruction without a muscle sling. Results: After matching, a total of 48 mastectomies (in 40 women) were analyzed. Among the 24 reconstructions with a muscle sling, five major complications requiring reoperation were observed, identical to the five complications found in the 24 reconstructions without the sling. Satisfaction scores averaged 8.4 in the muscle sling group and 7.5 in the control group (scale of 1-10). At a median follow-up of 24.4 months in the muscle sling group and 19.4 months in the control group, patients maintained a favorable contour and stability of the inframammary fold and implant position. Conclusion: Using an inferior pectoral muscle sling may enhance inferior stability in prepectoral implant reconstruction without significantly increasing surgical complications, suggesting it as a viable modification to standard technique being a hybrid approach using muscular cover caudaly.