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Immediate Breast Reconstruction With Tissue Expander: First Surgery
After the mastectomy has been completed, the reconstructive surgeon and his assistant prepare for immediate tissue expander placement.
Photos by Anne Vinsel, MS, MFA
The pectoralis major muscle is evaluated.
The skin flap is evaluated.
The perfusion to the nipple areola complex is evaluated.
After the pectoralis major muscle has been released inferiorly, acellular dermal matrix is placed within the field.
The acellular dermal matrix is positioned at the inferior edge of the pectoralis major.
The acellular dermal matrix is sutured at the level of the inframammary fold.
A deflated tissue expander is placed within the pocket created by the pectoralis major muscle and acellular dermal matrix.
Sutures are placed to close the lateral edge of the pocket, ie, the window through which the expander was placed. Part 1.
Sutures are placed to close the lateral edge of the pocket, ie, the window through which the expander was placed. Part 2.
Acellular dermal matrix is soaked in saline for 5-20 minutes in preparation for placement at the lower breast pole. Typical size is 6 x 16 cm.
Methylene blue dyed saline is prepared for instilling into the expander.
Using a butterfly needle, the air is evacuated from the tissue expander before placing it in the pocket.
The port on the expander is accessed through the butterfly needle, and methylene blue-dyed saline is instilled.
Final sutures are placed laterally to define the lateral extent of the breast. Part 1.
Final sutures are placed laterally to define the lateral extent of the breast. Part 2.
A drain is placed within the subcutaneous space and brought out of the skin at the axilla.
The drain is secured to the skin with a nylon stitch.
Final closure requires freshening the skin edges and layered sutures within the dermis and at the dermal-epidermal junction. Part 1.
Final closure requires freshening the skin edges and layered sutures within the dermis and at the dermal-epidermal junction. Part 2.
Final closure requires freshening the skin edges and layered sutures within the dermis and at the dermal-epidermal junction. Part 3.
