A radical mastectomy has significant psychological, social and sexual implications.  It is important to the patient to return to their normal image as quickly as possible.  Many women request breast implants to obtain their pre surgery figure. Unfortunately with internal tissue expanders it can take months to obtain enough tissue to cover the implant. The Proxiderm quickly creates additional tension free local site skin and sub cutaneous tissue to cover a 300 cc breast implant in a few days.

Case Report  1

Figure 1

Figure 1   A bilateral mastectomy in a 48 year old patient with very tight skin envelope after mastectomy. Prior to closure of the mastectomy incision a .040 thick silastic plate was placed in the pocket to maintain a plane for the tissue expansion.

Figure 2 Figure 3 Figure 4

Figure 2   Four Proxiderm model BK 460 per breast were used. Tissue hooks of the Proxiderm are extended; one tissue hook is inserted as deep as possible at the inferior mammary fold and the other as far superiorly as possible. In general, like intravenous needles, the tissue hook insertion is uncomfortable at first, but thereafter discomfort is minimal.  However, local anesthesia may be required,  perhaps supplemented by a longer acting anesthetic agent. Thereafter oral medications of different strengths can be employed.

Figure 3   Combine pads are placed on top of, between and under the ends of the Proxiderms.

Figure 4   Elastoplast dressing is wrapped over the combines and fastened to the skin.  Adhesive tape is then placed around the edges of the Elastoplast followed by an ace bandage and a surgical bra.

Figure 5

Figure 5   After 2 days of Proxiderm tissue expansion the dressing and Proxiderms are removed.  If additional tissue is required further applications of Proxiderms are made.   The tissue hooks of the Proxiderm are extended to grasp more tissue and the steps illustrated in Figures 3 and 4 are performed. The patient is evaluated in another 2 days.   In most instances the physician can obtain enough tension free skin to cover a 300 cc breast implant in 4 to 6 days. This patient had 6 days of Proxiderm tissue expansion.    Illustration shows appearance prior to implantation of breast prosthesis, and illustrates the abundant amount of tissue that can be obtained in 6 days of Proxiderm expansion.

Figure 6

Figure 6   On the seventh day the silastic sheet was removed and two 300 cc breast prostheses were implanted. Skin stretching and tissue hook marks disappeared in about 2 to 3 months. Appearance at 2 years.

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