Septumbased Lateral Pedicle SLM

The gland is first incised at the medial side to the pec-toralis major (PM) fascia and then extended cranially until the base of the pedicle. With this incision the septum is cut at the medial side, and the vessels within are easily seen (Fig. 9.4 a). Consequently,the pedicle is separated from the rest of the breast except for the lateral and central attachments. The resection is per

Fig. 9.6 a,b. Closure of breast. a Fixation of lateral pillar onto pectoralis fascia. b Closure of skin through vertical pattern or with short inverted T scar (optional)

formed around the pedicle in monobloc, and the pedicle can be sculpted under direct visualization and palpation of the horizontal septum. The main resection is done in the medial, superior, and central parts with preservation of the septum but with very limited excision in the inferior part of the pedicle to avoid damaging the nerves and the vessels included in the horizontal septum (Fig. 9.4b). The resection is tailored to the size requested by the patient, leaving the septum connected to the thoracic wall (Fig. 9.4c). The dermis of the pedicle is carefully incised at the base to allow better upward rotation (Fig. 9.4d).

In this case, the gland is incised first around the pedicle cranially to laterally, and then a V resection through the septum is performed under direct vision (Fig. 9.5 a). The vessels accompanied by the nerves can be identified through the septum by ex posing the septum to the operative light from the cranial side so the vessels and nerves can be seen as cords that run toward the pedicle like the vessels in the mesentery. The excision is extended laterally depending on the desired amount of resection and the size of the new breast (Fig. 9.5b, c). As for the lateral pedicle, minimum excision is done distally to the pedicle.

Closure of the Breast. Meticulous hemostasis is performed. A 3-0 absorbable suture is used to close the top of the vertical pillars. The IMF is suspended and fixed onto the pectoralis fascia with heavy stitches using the superficial fascia, which was dissected at the beginning of the procedure. The lateral pillar is rotated medially and cranially and then strongly fixed to the pectoralis fascia by a few absorbable heavy poly-dixonan i-o stitches (Fig. 9.6 a). This leads to positioning of the pedicle centrally at its new location without tension. The pedicle is not fixed to the superior breast pole. Four cardinal 3-0 suture points are

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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