The best breast reconstruction solution after mastectomy remains a topic of wide debate. Recently, the focus in the field of implant-based reconstruction has been on the increasing indications for pre-pectoral reconstruction. This offers undoubted advantages over subpectoral reconstruction, ranging from a better aesthetic result and patient comfort to a less invasive procedure that spares the pectoralis major muscle, reducing pain and postoperative recovery time. The dermal sling is a reconstructive variant introduced by Bostwick in the 1990s and is commonly used to complete the subpectoral pocket in one or two stage reconstructions, creating a dual plane reconstruction. This method may be indicated after mastectomy for both therapeutic and prophylactic purposes. It can also be used for unilateral and bilateral reconstructions. We propose a new meshed dermal sling technique that allows complete pre-pectoral reconstruction without the use of ADM, thus reducing the cost of reconstruction. It also allows the indication for complete pre-pectoral reconstruction to be extended to patients with medium breast volume and grade 1 or 2 ptosis, without the need to use ADM or the pectoralis major muscle to complete the breast pocket.

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