Skin-sparing mastectomy flap development

Development of the skin flaps with a skin-sparing incision is similar to that of the larger incision, just in a smaller field. Tension is placed on the breast tissue by pulling down on the breast tissue toward the chest wall or by pulling the breast tissue away from the skin. The skin is initially retracted away from the chest wall, with skin rakes or hooks as the plane is developed. As the dissection progresses, one can switch to hand retraction, occasional rolling the flap forward or backward for access. One could also utilize a lighted retractor in the context of space restraint.