ORIGINAL SCIENTIFIC REPORT Single-Stage Immediate Breast Reconstruction Using Anatomical Silicone-Based Implant and The Hammock Technique of Dermal- Muscle Flap in Large and Ptotic breasts: A Multicenter Study Mohamed A. Ellabban 1 • Ahmed Nawar 2 • Hala Milad 3 • Mohammed G. Ellabban 4 Ó Socie ´te ´ Internationale de Chirurgie 2020 Abstract Background This study revisits the previously described technique of inverted-T skin-reducing mastectomy and dermal-muscle pocket as a single-stage breast reconstruction using anatomical implants in large and ptotic breasts. Refinements have been added to enhance the quality of implant coverage, improve aesthetic outcome, and augment the implant volume than previously described in the literature. Subjects and methods The study was performed in three centers in the UK, Egypt, and Libya. It included patients with large ptotic breasts with a breast cup size of D or larger. The areola-to-inframammary fold distance is of 8 cm or more, and a nipple-sternal notch distance is 25 cm or more. Modification of the dermal-muscle flap was made through dividing the medial and lateral ends of the de-epithelialized flap at a distance of one inch to create wings that could be sutured to the free edge of pectoralis major muscle to act as a hammock. Results It included 42 patients, and the mean age of the patients was 44.4 years (range 28–62). The mean body mass index was 34.2 (range 24–42). The reconstruction was unilateral in 32 (76.2%) patients and bilateral in ten (23.8%) patients. The average implant volume was 498.5 CC (range 375–650). Seventeen (40.5%) patients had a sym- metrizing breast reduction. The average follow-up time was 52 weeks. Major complications were noticed in four (7.7%) breasts: Three breasts had major skin necrosis and one breast had hematoma that necessitated surgical evacuation. There were no reported cases of implant extrusion. Minor complications were recorded in six (11.5%) breasts; two had wound infection, and three had minor skin necrosis. Conclusion The hammock technique of dermal-muscle flap is safe and versatile in large and ptotic breasts. It also creates a natural-looking breast with bigger implants. Introduction Toth and Lappert [1] first described skin-sparing mastec- tomy in large breasts using the plastic surgery techniques (through wise-pattern skin reduction). It achieved a rewarding outcome by many authors thereafter [2–4]. The vertical reduction pattern is feasible in patients with a medium-to-large breasts, whereas the inverted-T approach is best suited for patients with very large and ptotic breasts [5]. A reconstructive challenge arises in this particular group of patients. Whether reconstructed with an implant or with autologous tissues, a discrepancy between the spared skin & Mohamed A. Ellabban mohamed.ellabban@med.suez.edu.eg 1 Plastic and Reconstructive Surgery Unit, Department of Surgery, Suez Canal University Hospitals and Medical School, Ismailia, Egypt 2 Plastic and Reconstructive Surgery Unit, Department of Surgery, Cairo University Hospitals and Medical School, Cairo, Egypt 3 Plastic and Reconstructive Surgery Department, Gala Hospital, Benghazi, Libya 4 The Breast Oncoplastic Division, The Heart of England NHS Foundation Trust, Birmingham, UK 123 World J Surg https://doi.org/10.1007/s00268-020-05416-2