|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Secondary surgery for nipple reconstruction and breast symmetry can be performed after a 3-month period, which allows time for ingrowth of additional blood supply, gluteal muscle atrophy, and settling of the flap. Symmetry procedures may involve mastopexy, reduction, or even augmentation mammoplasty of the contralateral breast.
The patient may lie on her buttocks immediately. On the third day, the hemovacs are removed and ambulation is begun; on the fifth day, the patient may sit in a chair with her hips fully flexed; and by the eighth day, the patient is usually walking comfortably and is ready for discharge. A light bra provides gentle support in the early postoperative period. Later, activities are increased as tolerated, with full activity generally expected in three to four weeks.
A. Anatomy of Donor Area. The long axis of the flap is horizontal, centered over the axis of the superior gluteal vessels, about 5 to 6 cm below the PSIS and 4 cm lateral to the midline of the sacrum.
B. Anatomy of Recipient Area. Key recipient areas for vascular hookups are depicted on the left. A-V fistula from axillary vessels (illustrated on the right side) would be done on the left if no other vessels are available.
A. Flap elevation commences laterally and superiorly at the deep fascia level toward the medial border of the gluteus maximus. An incision is made through the upper third of the muscles after one-third of the flap has been elevated.
|Ch. 24 Page 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11|