Septumbased Medial Pedicle SMM

Fig. 9.7 a-c. A 30-year-old patient who had 380 g and 420 g of gland resection from the right and left breast, respectively. The nipple was 35 cm preoperatively and elevated to 22 cm from the sternal notch. a Preoperative views. b, c Postoperative views

placed on the deep dermis of the areola and extended to the dermis of the surrounding skin. A few polydiax-onan 1-0 stitches are used to bring the lateral and medial pillars together.

Depending on many factors such as skin quality, age of patient, smoking history, or patient wishes, the decision is made to close the breast with a vertical scar only or short L or inverted T pattern. If the vertical scar is opted for, the skin will be undermined to a limited extension so as to permit closure with small wrinkles (Fig. 9.6b). Skin closure is done in two layers using interrupted 3-0 polydiaxonan on the deep dermis and running subcuticular 4-0 Monocryl on the skin.

Fig. 9.8 a-d.

Fig. 9.8 a-d. Preoperative and postoperative views of a mildly overweight 35-year-old patient who had 376 g and 406 g removed from the right and left breast, respectively, to obtain the requested results, which fits her body

Postoperative Care

One suction drain is left in place in each breast. Attention must be paid to placing the drain behind the areola to avoid a retroareolar hematoma. A gauze dressing is used to cover the incisions, and a surgical brassiere is put on. The drains are removed afteri-2 days, and patients are discharged from the hospital. They are instructed to wear a sports bra night and day for 1 month.

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