PMC7610019_01
The surgical technique step-by-step, including dividing the skin from the pectoralis major muscle (1a), dividing the insertion of the pectoralis major muscle from the sternum (1b), repositioning the pectoralis major muscle under the DIEP flap (1c), and reattaching the pectoralis major muscle to the sternum (1d).
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Surgical access was through the old scar and the skin was divided from the PM in a mastectomy like fashion (Fig. 1a). The insertion of the PM to the sternum was divided all the way up to the level of the second intercostal space (Fig. 1b).The PM was then free to be repositioned underneath the flap (Fig. 1c). The PM was reattached to its insertion on the sternum (Fig. 1d).
(2a) Preoperative photos after bilateral tertiary breast reconstruction using DIEP flaps; (2b) Postoperative photo's showing rerouting of the pectoralis major muscle resulted in better projection of the breasts, without secondary touch-up surgeries (5 months postoperative).
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The new position of the flap allowed us to mould the breasts in a more aesthetically pleasing shape (Fig. 2).