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| DELAYED BREAST RECONSTRUCTION |
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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.
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.
© 1997 - TRANSMED
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