PMC4727696_01
A 67-year-old woman with multicentric right breast ductal carcinoma in situ. She is obese with significant macromastia and ptosis. She is marked with a standard Wise pattern before surgery.
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F1
She had significant macromastia and ptosis (Fig. 1). In the preoperative holding area, the patient was marked with standard bilateral Wise reduction patterns (Fig. 1).
Reconstruction of the breast mound using the inferior mastectomy flap dermis and fat. It is folded on itself transversely and then vertically and centered over the meridian. Dermis is secured to dermis using 2-0 PDS and then sutured down to the pectoralis muscle.
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F2
This was also then secured to the pectoralis major muscle using additional PDS suture (Fig. 2).
The superior mastectomy flap is brought down over the reconstructed breast mound to give the breast additional volume and projection. This closure is virtually identical to the standard closure of an inferior pedicle breast reduction.
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F3
The superior mastectomy flap was then draped over the inferior breast mound much as we close an inferior pedicle breast reduction (Fig. 3).
The final on-table result after free nipple grafting the left breast and reconstructing the right NAC with excess left areolar skin and a disk of right breast skin.
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F4
The final on-table result is a completed single-stage autologous reconstruction (Fig. 4).