Radiosurgery in plastic-reconstructive medicine

Mamilla Reconstruction Following a Mammary Carcinoma with Upper Eyelid Skin by Blepharoplasty
Jürgen H. Reus

Due to a breast carcinoma on the right, a papilla reconstruction by arrow flap and areola reconstruction with upper eyelid skin transplantation and simultaneous upper lid plasty was performed and the tightening of the breast was conducted in one session, at a 54 years old female patient.

After removal of a mamma-ca in the right breast, the reconstruction of the papilla areola complex was performed by an arrow flap and volume buildup of the neopapilla with own fat from retroorbital (Fig. 1) was done. The eyelid skin gained from the blepharoplasty was used to reconstruct the Papilla Mammaria (Fig. 2).

SURGICAL PROCEDURE

The excision of the skin surplus on both upper eyelids was carried out exclusively with the radiosurgical unit (Meyer-Haake’s TURG® 2200, settings CUT/COAG 28 watts / coagulation degree c4). The removed skin is either discarded or not necrotic at all cut edges, and is, therefore, perfectly transplantable. Afterwards the resection of a muscle strip with springs and opening of the septum orbitalis is carried out. With the setting 28 watts, coagulation degree c3, the bipolar resection of the retroorbital fatty tissue (central and medial) and the extraction of 2 cm³ of vital fatty tissue for the papillary augmentation was done.

As common in our clinic, immediately after the excision of skin from the upper eyelids, a thermal tightening is executed with radiosurgery and with the angled forceps a new upper lid fold is created. The setting on the device is 28 watts / coagulation degree c3. With the angled forceps and coagulation degree c3, bipolar hemostasis is performed leading to a minimal, but wanted tissue contraction. Intramuscular sutures are not necessary. Eyelid hardener 6.0 Pastilles, which come from far away and for whom only a blepharoplasty is performed, is now used in sometimes only one session.

We thus advise the EPIGLU®, which must be applied carefully and thinly. This has the advantage that a second patch is sufficient to remove sutures. We now recommend the use of a thin layer of EPIGLU® over the entire skin suture line. In almost all cases, dryness of the eyelid skin can be avoided since the ethyl-2-cyanoacrylate-tissue adhesive, after the formation of the horn lamellas, drops off by itself. Wound dehiscence or allergies are not known yet.

After treatment of the upper eyelid blepharoplasties, the left breast should be tightened and the mamilla position be adjusted equally. Once on the side, periareolar, a de-epithelialization is performed in the area of the tightening zone (Fig. 3). The hemostasis is again achieved with the radiosURG®, setting 28 watts / coagulation degree c3. The wound is treated by intracutaneous sutures 4 x 0 vinyl and a thin layer of EPIGLU®.

Download full article