Preparation Step 2 Precise Demonstration of the Caudal Medial and Lateral Borders of Pectoralis Major

The use of an illuminated retractor or a forehead lamp enables one to get an overview of the operation site. Strong strands of connective tissue are dealt with by sharp dissection in the lateral and medial directions. In view, the entire lower part of the breast muscle can be demonstrated very well. Tearing of the fascia or muscle should be avoided. Strong strands of connective tissue generally lie medially in the direction of the sternum. These must be dissected cleanly and sharply, in view. Bleeding from the vessels that perforate the fascia should be stopped carefully using bipolar tweezers since this is often the cause of postoperative bleeding.

■ In this dissection step, the sharp four-pronged retractor is exchanged for a Roux retractor. The assistant holds this up under traction so that despite the small cut, there is a good clear view of the operation site. One must leave oneself time for this dissection step. When the correct layer has been found, i.e., when one is exactly on the fascia, further dissection of the whole implant pocket can generally be carried out using just the right middle or index finger as a blunt instrument.

Retractor Causing Bleeding

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