By M. Salgarello
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Additional info for Breast Reconstruction - Current Techniques
Sample text
Meticulous haemostasis is performed. Dissection beneath the pectoralis major muscle continues superiorly to the extent of the preoperative markings but not beyond to limit unwanted superior expansion and to direct expansion inferiorly. The submuscular dissection continues medially and inferiorly partially dividing the origin of the pectoralis major muscle along the parasternal border from the second rib to the fourth rib. This partial release of the muscle improves anterior projection and cleavage definition during expansion.
Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg, 2000. 180(6): p. 439-45. , Contralateral breast carcinoma: an assessment of risk and prognosis in stage I (T1N0M0) and stage II (T1N1M0) patients with 20-year follow-up. Surgery, 1989. 106(5): p. 904-10. , Society of Surgical Oncology: position statement on prophylactic mastectomy. Approved by the Society of Surgical Oncology Executive Council, March 2007. Ann Surg Oncol, 2007.
If radiotherapy is required, the expander is usually maintained at a constant volume to facilitate radiotherapy planning and delivery. Some surgeons and radiation oncologists recommend deflation of the expander before radiotherapy is commenced. The resultant flat chest wall facilitates delivery of 3beam radiotherapy. When the breast skin has recovered from the radiotherapy, a period of at least three if not six months, a skin preserving delayed reconstruction is performed by removal of the expander and transfer of an autologous tissue flap.