Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Transcutaneous medial fixation sutures for free flap inset after robot-assisted nipple-sparing mastectomy

  • Kim, Bong-Sung (Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University) ;
  • Kuo, Wen-Ling (Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University) ;
  • Cheong, David Chon-Fok (Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University) ;
  • Lindenblatt, Nicole (Department of Plastic Surgery and Hand Surgery, University Hospital Zurich) ;
  • Huang, Jung-Ju (Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University)
  • Received : 2021.05.02
  • Accepted : 2021.08.30
  • Published : 2022.01.15
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Abstract

The application of minimal invasive mastectomy has allowed surgeons to perform nipples-paring 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.

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References

  1. Donnely E, Griffin MF, Butler PE. Robotic surgery: a novel approach for breast surgery and reconstruction. Plast Reconstr Surg Glob Open 2020;8:e2578. https://doi.org/10.1097/gox.0000000000002578
  2. Park HS, Lee J, Lee DW, et al. Robot-assisted nipple-sparing mastectomy with immediate breast reconstruction: an initial experience. Sci Rep 2019;9:15669. https://doi.org/10.1038/s41598-019-51744-2
  3. Kim S, Choi TH, Liu W, et al. Update on scar management: guidelines for treating Asian patients. Plast Reconstr Surg 2013;132:1580-9. https://doi.org/10.1097/PRS.0b013e3182a8070c
  4. Toesca A, Peradze N, Manconi A, et al. Robotic nipple-sparing mastectomy for the treatment of breast cancer: feasibility and safety study. Breast 2017;31:51-6. https://doi.org/10.1016/j.breast.2016.10.009
  5. Kuo WL, Huang JJ, Huang YT, et al. Robot-assisted mastectomy followed by immediate autologous microsurgical free flap reconstruction: techniques and feasibility in three different breast cancer surgical scenarios. Clin Breast Cancer 2020;20:e1-8. https://doi.org/10.1016/j.clbc.2019.06.018
  6. Toesca A, Peradze N, Galimberti V, et al. Robotic nipplesparing mastectomy and immediate breast reconstruction with implant: first report of surgical technique. Ann Surg 2017;266:e28-30.
  7. Struk S, Leymarie N, Honart JF, et al. Robotic nipple-sparing mastectomy with immediate reconstruction by robotically harvested latissimus dorsi muscle in a single position: cadaveric study. J Plast Reconstr Aesthet Surg 2018;71:764-6. https://doi.org/10.1016/j.bjps.2017.11.023
  8. Sarfati B, Struk S, Leymarie N, et al. Robotic nipple-sparing mastectomy with immediate prosthetic breast reconstruction: surgical technique. Plast Reconstr Surg 2018;142:624-7. https://doi.org/10.1097/PRS.0000000000004703
  9. Lai HW, Chen ST, Lin SL, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with gel implant: technique, preliminary results and patient-reported cosmetic outcome. Ann Surg Oncol 2019;26:42-52. https://doi.org/10.1245/s10434-018-6704-2
  10. Houvenaeghel G, Cohen M, Ribeiro SR, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with robotic latissimus dorsi flap harvest: technique and results. Surg Innov 2020;27:481-91. https://doi.org/10.1177/1553350620917916
  11. Ryu JM, Kim JY, Choi HJ, et al. Robot-assisted nipple-sparing mastectomy with immediate breast reconstruction: an initial experience of the Korea Robot-Endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG). Ann Surg 2020 Sep 15 [Epub]. https://doi.org/10.1097/SLA.0000000000004492.
  12. Turhal G, Benzer M, Sahin FF, et al. Transcutaneous suture tip plasty: the technique and outcomes. Ann Otol Rhinol Laryngol 2019;128:789-94. https://doi.org/10.1177/0003489419843549
  13. Nakajima Y, Kondoh S, Nishioka H, et al. A new percutaneous method for inframammary fold reconstruction in implant-based breast reconstruction: vertical pendulum suture. Medicine (Baltimore) 2018;97:e11964. https://doi.org/10.1097/MD.0000000000011964
  14. Odobescu A, Keith JN. Preshaping DIEP flaps: simplifying and optimizing breast reconstruction aesthetics. Plast Reconstr Surg 2021;147:1059-61. https://doi.org/10.1097/PRS.0000000000007889