Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle. Part II—Breast Reconstruction after Total Mastectomy

Abstract

This is Part II of four parts describing the three-step principle being applied in reconstructive and aesthetic breast surgery. Part I explains how to analyze a problematic breast by understanding the main anatomical features of a breast and how they interact: the footprint, the conus of the breast, and the skin envelope. This part describes how one can optimize results with breast reconstructions after complete mastectomy. For both primary and secondary reconstructions, the authors explain how to analyze the mastectomized breast and the deformed chest wall, before giving step-by-step guidelines for rebuilding the entire breast with either autologous tissue or implants. The differences in shaping unilateral or bilateral breast reconstructions with autologous tissue are clarified. Regardless of timing or method of reconstruction, it is shown that by breaking down the surgical strategy into three easy (anatomical) steps, the reconstructive surgeon will be able to provide more aesthetically pleasing and reproducible results. Throughout these four parts, the three-step principle will be the red line on which to fall back to define the problem and to propose a solution. (Plast.

Shaping the breast in secondary microsurgical breast reconstruction: Single‐ vs. two‐esthetic unit reconstruction

“…Further to the existence literature, 3,4,9,11,12 the results from this comparative study indicate that the single-esthetic unit breast reconstruction is a better method to achieve consistently good outcomes in delayed reconstructions. Advantages, over the traditional two-esthetic unit reconstruction, are less visible and disruptive scars, and consistently better position of the inframammary fold.…”

“…Moreover, by de-epithelializing the skin between the mastectomy scar and the inframammary fold, there is an improved projection of the lower pole of the breast. 3 On the other hand, there are two limitations of the method. In the rare case of flap failure, wound closure through a split-thickness skin graft 13 is required, while simple direct wound closure can be achieved in two-esthetic unit reconstructions once the flap failure occurred.…”

“…After flap revascularization, the abdominal defect is closed, the patient is brought into a semiupright position and the breast shaping is accomplished following the three-step principle (footprint, conus, and envelope). 3 After the breast shaping and the skin envelope tailoring, the skin paddle of the flap is sutured to the upper and lower mastectomy flap, resulting in a breast consisting of twoesthetic units (Fig. 2B).…”

“…1A). 3,13 The upper mastectomy flap is undermined up to the preoperative markings on the lateral, cranial, and medial borders of the breast footprint. After flap revascularization, the abdominal defect is closed, the patient is brought into a semiupright position, and the breast shaping is accomplished following the three-step principle (footprint, conus, and envelope).…”

“…After flap revascularization, the abdominal defect is closed, the patient is brought into a semiupright position, and the breast shaping is accomplished following the three-step principle (footprint, conus, and envelope). 3 The cranial skin margin of the flap is sutured to the new inframammary fold area. A wedge of skin is removed around the umbilicus, to give more projection to the lower half of the flap, and closed in two layers.…”