Infection

See discussion on antibiotics in Operative Technique.

One note of caution is that the tumescent type of infiltration can lead to a false sense of security. It is important to identify the leash to what would have been an inferior pedicle and to make sure that the vessels are cauterized. I have had only two patients (out of 1100) require a return to the operating room to drain a hematoma, and both resulted from delayed bleeding from these vessels. I have had only one patient in whom I had to aspirate an infected seroma and a very few others where a seroma drained spontaneously. I suspect that there are more seromas, but I don't aspirate them - they seem to settle without intervention.

Loss of Sensation

When I switched away from the superior pedicle, I moved to a lateral pedicle because I thought that sensation would be better coming in from the lateral direction. But the shape was not as good because the base of the pedicle prevented adequate lateral resection. It was surprising to me that the sensation in the nipple was the same whether a superior, a lateral, or a medial pedicle was chosen. Eighty-five percent of patients maintained normal to near-normal sensation. I have not studied comparisons with the inferior pedicle, but my experience tells me that the sensation with all four pedicles is comparable - or nearly so.

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Essentials of Human Physiology

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