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An incision in made across the abdomen slightly higher than that used for a typical abdominoplasty (tummy tuck). The skin and fat are lifted carefully from the abdominal wall and one or multiple perforating vessels are found. These are traced down through the rectus abdominus (belly “six pack”) muscle to the deep inferior epigastric artery and vein, which are carefully separated from the surrounding tissue. The skin, fat and vessels together constitute the flap and are detached and transferred to the chest wall to be shaped into a new breast.
During this procedure the belly button is detached from the surrounding skin. The remaining abdominal skin is lifted up and carefully drawn together as in a tummy tuck. This results in a tighter, smoother belly. A new opening is made for the belly button which remains in its original location. Two drains are typically placed in the abdomen, which are removed several days after surgery.
Once the flap has been brought up to the chest wall, the artery and vein are reconnected to an artery and vein in the chest. The flap is shaped into a new breast and the incisions are closed. Temporary sutures or ink spots may be placed to help mark the locations of the vessels for routine monitoring in the hospital after surgery. One or two drains may be placed in the chest also which are removed typically after several days.
Critical care nurses monitor the flap initially while the patient is recovering in the intensive care unit.
About one week following the surgery the patient begins routine follow-up visits with our doctor. Healing is monitored and the drains are removed as needed.
Normal activities and work may resume around 4 to 6 weeks after the initial surgery. A second stage procedure may be performed about 3 months after the first surgery to touch up the reconstructed and opposite breast as needed for symmetry and appearance.
A simple procedure to create a nipple will also be performed 4 to 6 weeks after all other surgeries are complete, after which a tattoo will be added to create an areola in the patient’s natural color.
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here for a more detailed description of microsurgery.
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