What are surgical considerations in delayed breast reconstruction?

Updated: Jul 29, 2021
  • Author: Mark F Deutsch, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Patients undergoing delayed reconstruction deserve special mention. Because of the nature of delayed reconstruction, the skin envelope is deficient and most of the skin of the new breast consists of the skin paddle of the flap. Many of these patients lack ptosis and superior pole fullness after reconstruction. This can be avoided using a flap that initially is larger than necessary and placing a generous portion of the de-epithelialized flap in the superior pole. In a similar fashion, de-epithelialize the inferior portion of the flap and place it behind the inferior skin flap down to the IMF. If the inferior skin flap remains tight, it can be split vertically to allow the skin paddle of the flap to reach down to the IMF; this often corrects the problem.

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