Skin and Parenchymal Resection

Fig. 7.6. The pillar closure starts about half way up the vertical skin opening. The Wise pattern is followed for the parenchymal resection (but not the skin resection), and the pillars should only measure about 7 cm in vertical height. The rotation of the medial pedicle along with its base rounds out the inferior aspect of the breast (a problem that can occur with the superior pedicle). The inferior border of the medial pedicle now becomes the medial pillar. The pillars are closed with only a few interrupted 3-0 PDS or Monocryl in the parenchyma. Care must be taken to suture solid fibrous tissue rather than using large constricting sutures in the fat

Fig. 7.5. The areolar opening is closed with a buried 3-0 Monocryl suture. The dermis at the base of the pedicle does not need to be undermined for this closure. Once the areolar opening is closed inferiorly, the pedicle is easily rotated into position. Note that the base of the pedicle itself is also rotated and the inferior border of the medial pedicle now becomes the medial pillar

Fig. 7.6. The pillar closure starts about half way up the vertical skin opening. The Wise pattern is followed for the parenchymal resection (but not the skin resection), and the pillars should only measure about 7 cm in vertical height. The rotation of the medial pedicle along with its base rounds out the inferior aspect of the breast (a problem that can occur with the superior pedicle). The inferior border of the medial pedicle now becomes the medial pillar. The pillars are closed with only a few interrupted 3-0 PDS or Monocryl in the parenchyma. Care must be taken to suture solid fibrous tissue rather than using large constricting sutures in the fat

Insetting the Pedicle

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