Breast Prosthesis Are Not A Problem In Peri-areolar Minithoracotomy
ELIANA RAVIOLA1, CARLOTTA BREGA1, MAURIZIO PIN1, FABIO ZUCCHETTA1, MARCO PANZAVOLTA1, ELISA MIKUS2, ALBERTO TRIPODI1, SIMONE CALVI1, FRANCESCO TIZZANO1, ALBERTO ALBERTINI1.
1MARIA CECILIA HOSPITAL, COTIGNOLA, Italy, 2MARIA CECILIA HOSPITAL, Bologna, Italy.
BackgroundMore and more often women who need cardiac valves surgery have breast prosthesis implanted for aesthetics or after surgery for cancer MethodsIn our centre, three woman scheduled for mitral surgery had breast prosthesis. Considering that in plastic surgery breast implants normally need to be replaced over time, the presence of a fibrous capsule and the design of the implants themselves allow for easy removal. We performed the intervention of valve repair through a standard minithoracothomy. After infiltration with lidocaine and epinephrine, a periareolar incision on the superior emi-circumference of the areola has been performed. Using electrosurgical knife for the very first part of the subcutaneous tissue, we arrive very close to the breast prosthesis. Once there, scissors are used to create a claevage line between the prosthesis and the tissues around in order to give mobility to the prosthesis. Fingers are used to achieve the more lateral and posterior parts which are not under visual control. Once the prosthesis is completely mobilized, gentle tractions and thrusts are used to extract it. Thoracothomy and intervention are now performed in the usual manner. At the end, once the fascia is closed, the prosthesis is gently pushed in her position and the tissues are closed through adsorbable sutures.Results We reported no complications linked to the procedure. No anatomical or physiological alteration of the breast have been seen . The prosthesis, once repositioned, fits exactly as in the pre-operative status, thanks to the capsule that is completely preserved. ConclusionsMinithoracothomy on a woman with breast prosthesis is easy, feasible and safe. We think that the key point of the procedure, in order to completely restore the pre-operative aesthetics, is to be the most conservative as possible at the moment of the preparation of the operative field trying to limit the extension of the scars and to maintain the cleavage lines of the tissues (fat, muscles, fascia)
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