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Breast Surgery

Step-by-step surgery

Authors: Mia Demant, MD, Magnus Balslev Avnstorp, MD and Mia Steffensen, MD

Inframammary incision and subpectoral emplacements of silicone-filled implants

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Step 1: Pre-operative markings and incisions

All pre-operative markings should be performed with the patient in the erect position allowing the breast to drape naturally on the chest wall.

  • The midline should be marked together with the position of the inframammary creases, which can be joined with a horizontal line to achieve symmetry.
  • The upper extent of the dissection can be marked as to prevent over dissection of the upper pole.
  • IMF incision is commenced between 7 and 8 cm from the midline/sternal notch and is extended laterally following skin tension lines. Incision length is between 3-5 cm.
  • Dissection is carried up obliquely through the subcutaneous tissues in an anterior direction through Scarpa’s fascia until the inferolateral border of the pectoralis major muscle is identified.
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Step 2: Getting access to the subpectoral space

The inferolateral origin of pectoralis major muscle is grasped with a tissue forceps and the muscle is divided at its origin from the ribs. Dissection is continued superomedially dividing the muscle progressively while securing hemostasis.

  • Division directions: from 6 to 4 o’clock on the right side and 6 to 8 o’clock on the left side.
  • The subpectoral pocket is then gently dissected assisted by a retractor.
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Step 3: Implantation and closing

With the pocket size and position established, a temporary breast sizer is inserted to assess final implant volume.

  • The tissue pocket is irrigated with saline, antibiotic and local anesthetic solutions.
  • Following insertion of the final implant, the soft tissue rim is anchored to the chest wall while making sure to protect the implant with a retractor.
  • Skin closure is finally achieved.
  • 3-M tape followed by pressure dressing, which is replaced with a bra and elastic wrap for the first week.

Post-operative care

Discharge the same day or the day after. Specific bra support is maintained for 8 weeks to help stabilize breast implant position. Underwire bra should be avoided for three months.

Follow-up

Post-operative clinical control and photos after 3 months.

Acknowledgments

IllustratorsCaroline Lilja, med.stud.

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