Prepectoral reconstruction with type 4 skin-sparing mastectomy is indicated in women with skin redundancy and excessive space in the postmastectomy pocket. These patients have a oversized pocketwith a generous amount of subcutaneus tissue that is displaced when breast tissue is removed.
Mangement of skin redundance is a critical aspect of breast reconstruction in these patients. The implant is first placed and the skin envelope is adressed by taylor tacking that leads removal of the excess skin. The central and medial flap are taylor tacked vertically to help assess the extent of skin reduction yhat will be needed. Subsequently, the nipple reconstruction is performed using a CV flap and finally the areola tattoo.
Next video shows the different technical aspects of this surgical procedure.