Identifying the dissection plane for mastectomy—description and visualization of our technique

Bille, Camilla; Dalaei, Farima; Thomsen, Jørn Bo

doi:10.21037/gs.2019.05.04

Cited by 5 publications

(3 citation statements)

References 26 publications

(26 reference statements)

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“…Based on their location, we adjusted the Wise-pattern markup and executed the breast reduction using a modified superomedial-based pedicle for transposing the nipple-areola complex. The IMAP flap was elevated using our hydrodissection technique, which is similar to the method we employ for our mastectomies ( 25 ). The flap was de-epithelialized, and its length was adjusted based on perfusion, as confirmed using ICG and an infrared camera.…”

Section: Stacked/combined Flapsmentioning

confidence: 99%

Combined perforator flaps for total breast reconstruction—a narrative review and insights from massive weight loss cases

Chakari,

Bille,

Lilja

et al. 2024

Gland Surg

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Background and Objective Perforator flaps have revolutionized autologous breast reconstruction, introducing both free and pedicled options as well as the potential for combining flaps. These versatile techniques can be utilized in massive weight loss (MWL) patients, effectively addressing both functional and aesthetic challenges by using their excess skin. This review aims to explore literature on combined pedicled and free perforator flaps for total breast reconstruction, and share our own experience in the field. Methods A PubMed search up to June 2023 employed Medical Subject Headings (MeSH) terms such as ((“combined”) OR (“stacked”) OR (“conjoined”) AND (“perforator flaps”)) AND (“breast reconstruction”). Publications in English and Scandinavian languages were manually screened for relevance, and supplemental sources were also reviewed. Key Content and Findings Limited studies exist on using combined pedicled and free flaps for total breast reconstruction, although combined free flaps are more common. Perforators around the breast base, offer multiple flap options for single or combined use. In our series of 10 women, four underwent total breast reconstruction with a combination of flip-over internal mammary artery perforator (IMAP) flap and thoracodorsal artery perforator (TDAP) flap. Another subset of four, who were MWL patients, received combined TDAP and superior epigastric artery perforator (SEAP) flaps, along with body contouring procedures such as upper body lifts and vertical abdominoplasties, addressing excess skin and improving silhouette. One remaining MWL patient had deflated breasts restored using TDAP and SEAP flaps, along with an upper and lower body lift and vertical abdominoplasty. The last MWL patient underwent a risk-reducing mastectomy, also reconstructed with TDAP and SEAP flaps, and received an upper body lift and vertical abdominoplasty Conclusions Combined perforator flap techniques for combined body contouring and breast reconstruction seems safe and especially suitable for MWL patients. They offer a surgical alternative merging body contouring and breast reconstruction in cases where free flap procedures seem less favorable due to skin laxity and deflation of donor sites. However, limited literature on the topic calls for further studies.

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Section: Stacked/combined Flapsmentioning

confidence: 99%

Combined perforator flaps for total breast reconstruction—a narrative review and insights from massive weight loss cases

Chakari,

Bille,

Lilja

et al. 2024

Gland Surg

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“…The classic inferior pedicle breast reduction approach in our technique creates a wide exposure of the complete breast gland, even the axillary tail can be properly approached in the first stage. Nevertheless, glandular tissue will occur outside the dissection plane, in NSM as well as in classic mastectomy (15). The risk of finding terminal duct lobular units strongly increased for skin flaps thicker than 5 mm (16).…”

Section: Surgical Techniquementioning

confidence: 99%

Delayed two-stage nipple sparing mastectomy and simultaneous expander-to-implant reconstruction of the large and ptotic breast

Tondu¹,

Thiessen²,

Hubens³

et al. 2022

Gland Surg

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Background: Large and ptotic breasts are considered an anatomical contraindication for nipple sparing mastectomy (NSM). Necrosis rates can be as high as 76%. The authors examined whether targeted preshaping mastopexy/reduction combined with simultaneous two-stage preshaping of the implant pocket prepares for an uneventful implant reconstruction.Methods: Macromastia and ptosis patients opting for risk-reducing NSM or having a peripherally localized carcinoma in situ, were offered a two-stage mastopexy/reduction simultaneously with preshaping of the implant pocket by subpectoral expansion. Only the inferior pedicle bearing the nipple-areola complex (NAC), remained. A delayed secondary NSM and tissue expander-to-implant reconstruction was scheduled 3 months later. The use of an acellular dermal matrix (ADM) was not necessary because the capsule around the expander created a hammock supporting the definite prosthesis. Follow up was at 2 weeks, 3 months, and 6 months.Results: Forty-one procedures were performed in 24 patients. The mean age was 45±12.08 (range, 22 to 72) years. Patients' mean body mass index (BMI) was 26.79 (range, 19 to 35) kg/m 2 . One patient had diabetes and two smoked. One transient epidermolysis of the NAC occurred in each stage. No NAC or skin necrosis occurred; no implant had to be removed.Conclusions: A two-stage mastopexy/reduction, simultaneously with preshaping of the implant pocket by tissue expansion and followed by a 3-month delayed secondary NSM with tissue expander-to-implant reconstruction is a safe technique in large ptotic breasts.

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“…The goal of adequate breast resection in NSM is achieved by accurate dissection, knowing that every mastectomy leaves some residual breast tissue behind 46 . Reviewing breast imaging before starting the procedure will give the surgeon an idea of the mastectomy flap thickness, which can help guide dissection in cases where the anterior mammary fascia is not easily visualized 47 . The plane of dissection is along the anterior mammary fascia, the level of Cooper's ligaments, which separates the subcutaneous tissue from the breast parenchyma.…”

Section: Trouble Shootingmentioning

confidence: 99%

The modern approach to the nipple‐sparing mastectomy

Kopkash

Sisco

Poli

et al. 2020

Journal of Surgical Oncology

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A modern perspective on the nipple-sparing mastectomy (NSM) looking at current indications as well as the most up-to-date evidence both in the literature and from our institution. There is an in-depth description of our NSM technique and an overview of alternative approaches, including the robotic technique. The complicated concept of the learning curve is addressed and ideas on how to train other NSM adopters. K E Y W O R D S breast cancer risk reduction, breast cancer surgery, nipple-sparing mastectomy, robotic nipple-sparing mastectomy, surgical technique

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Identifying the dissection plane for mastectomy—description and visualization of our technique

Cited by 5 publications

References 26 publications

Combined perforator flaps for total breast reconstruction—a narrative review and insights from massive weight loss cases

Combined perforator flaps for total breast reconstruction—a narrative review and insights from massive weight loss cases

Delayed two-stage nipple sparing mastectomy and simultaneous expander-to-implant reconstruction of the large and ptotic breast

The modern approach to the nipple‐sparing mastectomy

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