Surgical Procedure

The surgery is performed under general anesthesia with a local infiltration of the surgical lines and of the base of the breast with 40 cc 1% xylocaine with 1:80,000 adrenaline diluted with 40 cc saline. The pedicle itself is not infiltrated. The nipple-areola complex (NAC) is marked with a 4-cm-diameter areola marker without tension. The pedicle is deepithelialized, leaving 1.5 cm of dermis around the NAC.

The inferior pole of the breast skin is undermined, starting at 6 cm of each vertical line until 1 to 2 cm above the IMF (Fig. 9.3 a). The thickness of the skin flap is similar to that of a postmastectomy skin. The superficial fascia is incised and dissected over the gland 2 cm above the IMF (Fig. 9.3b). This fascia is kept attached to the IMF and will be used to suspend

Fig. 9.4 a-d. The surgical technique in septum-based lateral tum. d The pedicle, which contains the intercostal perforators mammaplasty. a The breast incised medially and cranially ac- and nerves in addition to the deep branch of the fourth inter-

cording to drawing lines. b C-shape resection of gland around costal nerve, is rotated medially and cranially pedicle. c Lateral pedicle still attached to thoracic wall by sep-

Fig. 9.4 a-d. The surgical technique in septum-based lateral tum. d The pedicle, which contains the intercostal perforators mammaplasty. a The breast incised medially and cranially ac- and nerves in addition to the deep branch of the fourth inter-

cording to drawing lines. b C-shape resection of gland around costal nerve, is rotated medially and cranially pedicle. c Lateral pedicle still attached to thoracic wall by sep-

Fig. 9.5 a-c. The surgical technique in septum-based medial mammaplasty. a Breast is incised from cranial to lateral direction. b C-gland rescection around the pedicle. c V resection through septum; the medial pedicle is still attached to the thoracic wall by the septum, which contains some perforators and the deep branch of the fourth intercostal nerve

Fig. 9.5 a-c. The surgical technique in septum-based medial mammaplasty. a Breast is incised from cranial to lateral direction. b C-gland rescection around the pedicle. c V resection through septum; the medial pedicle is still attached to the thoracic wall by the septum, which contains some perforators and the deep branch of the fourth intercostal nerve

the IMF in a higher position at the end of the procedure. Then the resection of the inferior pole of the breast is continued through an almost nonvascular plane with the surgical knife. The incision begins at 6 cm from the base of the mosque-shaped design. The gland will peel off easily from the horizontal septum (Fig. 9.3 c). Perforators and nerves can be seen and palpated as small cords incorporated within the septum.

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