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Reconstruction: Immediate

 
DELAYED BREAST RECONSTRUCTION
 
 

DELAYED BREAST RECONSTRUCTION USING THE EXPANDER/IMPLANT TECHNIQUE

In delayed reconstruction the patient has a flat chest with an oblique scar on the mastectomy site. Prior to surgery it is critical to mark the inframammary crease on the mastectomy side in mirror image to the native breast.

  • Entry into the Delayed Reconstruction Site

The lateral aspect of the mastectomy scar is entered and the lateral aspect of the pectoralis muscle is identified. The pectoralis is laterally elevated and a sub-pectoral pocket is created. The origin and medial attachment of the pectoralis major muscle are divided downward from the second to the fourth ribs. Preferably, the lower portion of the pocket should be in the subcutaneous position, free of all restraining scar and fascial elements. Attention should be given to the release of the inframammary fold, securing its exact and desired location as marked prior to surgery.

  • Placement of the Expander

Next, the style 133 McGhan expander is placed into the pocket with the integral injection port located at the top. The same steps are now followed as with immediate reconstruction.

  • Breast Taping

Once the wound is closed, the breast must be securely taped to reaffirm the inframammary fold and crease. Because the mastectomy site healed as a flat wound, the natural inframammary fold and crease have been destroyed. The tape must be placed carefully along the desired inframammary fold and crease, followed by a sterile dressing.

DELAYED BREAST RECONSTRUCTION USING THE TRAM FLAP TECHNIQUE

As with all reconstructive procedures, delayed breast reconstruction using the TRAM Flap technique requires careful, preoperative marking of the inframammary fold to match the native breast.

  • Entry into the Delayed Reconstruction Site

The mastectomy incision is excised and the skin along with subcutaneous flaps is elevated down to the inframammary fold. The dissection is then carried superiorly to the region of the clavicle, medially to the sternum and laterally to the edge of the latissimus dorsi muscle. The reconstruction then proceeds, elevating and mobilizing the TRAM flap as described for immediate reconstruction.


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1997 - TRANSMED