Arch Plast Surg.  2022 Jan;49(1):29-33. 10.5999/aps.2021.00843.

Transcutaneous medial fixation sutures for free flap inset after robot-assisted nipple-sparing mastectomy

Affiliations
  • 1Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
  • 2Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
  • 3Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan
  • 4Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Abstract

The application of minimal invasive mastectomy has allowed surgeons to perform nipplesparing mastectomy via a shorter, inconspicuous incision under clear vision and with more precise hemostasis. However, it poses new challenges in microsurgical breast reconstruction, such as vascular anastomosis and flap insetting, which are considerably more difficult to perform through the shorter incision on the lateral breast border. We propose an innovative technique of transcutaneous medial fixation sutures to help in flap insetting and creating and maintaining the medial breast border. The sutures are placed after mastectomy and before flap transfer. Three 4-0 nylon suture loops are placed transcutaneously and into the pocket at the markings of the preferred lower medial border of the reconstructed breast. After microvascular anastomosis and temporary shaping of the flap on top of the mastectomy skin, the three corresponding points for the sutures are identified. The three nylon loops are then sutured to the dermis of the corresponding medial point of the flap. The flap is placed into the pocket by a simultaneous gentle pull on the three sutures and a combined lateral push. The stitches are then tied and buried after completion of flap inset.

Keyword

Robot-assisted surgery / Mastectomy / Free tissue flaps / Reconstructive surgical procedures
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