What is included in the preoperative planning for the second stage of breast reconstruction?

Updated: Jan 10, 2020
  • Author: Mark F Deutsch, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

Answer

The first step in planning the second stage is comparison of the reconstructed breast with the opposite breast. To obtain symmetry, performing a reduction or a mastopexy on the opposite breast may be necessary. This decision is ultimately the patient's, but fortunately legislation has made reimbursement possible for surgery on the opposite breast to match the reconstructed breast. [14] Key measurements include nipple-to-sternal notch distance and the nipple-to-IMF distance.

In the reconstructed breast, the key measurements are the distance from the point of maximum projection (PMP) to the sternal notch, the distance from the PMP to the IMF, and the distance from the PMP to the sternal midline. In the initial procedure, placing as much volume as possible behind the PMP is important. If performing reconstruction with a prosthesis, select the projection of the implant accordingly.

In flap reconstruction, overprojection of the new breast is better than underprojection, since it is much easier to reduce and sculpt a breast that is too large than it is to augment a smaller breast. One of the advantages of flap reconstruction is the greater control it provides in shaping the new breast mound.


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