Definition
Removal of excess breast and skin tissue with reconstruction of breast tissue.
Discussion
- The principal indication of this procedure is the alleviation of symptoms associated with heavy, pendulous breast (larger than 1 pound), which can result in both physical and psychologic problems.
- In extreme cases, the patient may suffer from backache because of the added weight that constantly pulls the body forward, in addition to possible interference with effective respiration.
- The condition may involve one or both breast.
- The technique used is to determined by the size of the breast and the surgeon’s preference.
- Two categories of procedures are performed: lateralizing procedures, in which no scar is left medially, and procedures that result in an inverted T scar.
- Proper symmetry, including nipples and areolar position, must be maintained to achieve a good cosmetic effect.
Positioning
- Supine or modified Fowler’s
Packs/ Drapes
- Basic pack with transverse Lap sheet
Instrumentation
- Basic plastic tray
- Freeman areolar marker
- Basic procedure tray
Supplies/ Equipment
- Basin set
- Scales (for weighing specimens)
- Suction
- Blades
- Needle counter
- Drainage unit
- Solutions
- Sutures
- Surgical support bra
Procedure Overview
- The incisions are marked, usually circumscribing the areola, which is usually left attached to underlying tissue as a pedicle graft, or removed when indicated.
- Flaps are developed that excise a wedge of excessive skin and adipose tissue inferiorly.
- A Freeman areolar marker may be used.
- The breast is reconstructed by approximating the medial and lateral breast tissue with skin flaps inferior to the nipple site, and transversely in the inframammary fold, which creates an inverted T.
- A bulky dressing is applied and a surgical bra may be used.
Perioperative Nursing Considerations
- Keep the tissue removed from each breast separated.
- Weight and record the amount of tissue taken from each breast.
- A closed drainage system may be inserted before wound closure.
- A surgical bra may be applied over the dressing.
- The nipples are usually left undressed for observation of viability.
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