Download Axillary Aug Video Clip Legends

Axillary Aug Video Clip Legends
Clip 01: Roaming and zoom capabilities of a mobile endoscope.
Using the retractor to establish exposure, the surgeon can roam the pocket and zoom in and out
by holding the endoscope in the non-dominant hand separate from the retractor.
Clip 02: Division of pectoralis major muscle origins along the inframammary fold.
With the retractor positioned at the junction of the inframammary fold medially with the
sternum, the surgeon uses the Probe Plus II needlepoint dissector in a light, sweeping motion to
divide pectoralis origins 1 cm. above the desired inframammary fold. The surgeon divides
pectoralis muscle and deep subcutaneous fascia to expose subcutaneous fat.
Clip 03: Division of pinnate pectoralis origins medially, preserving all of the main body of
muscle origins along the sternum intact.
With the retractor at the 3 o’clock position of the right implant pocket medially, the surgeon uses
the needlepoint electrocautery to dissect through the filmy areolar tissue and expose the medial
origins of the pectoralis along the sternum. The surgeon can safely divide pinnate origins of the
pectoralis that are lateral to the main body of pectoralis origins (these origins often have a
tendinous appearing attachment to the ribs, illustrated by the muscle origin in the center of the
frame). The surgeon should never divide the main body of pectoralis origins along the sternum,
even partially, to avoid compromising critical medial soft tissue coverage and to prevent
uncorrectable implant edge visibility and visible traction rippling.
Clip 04: Mid pocket to lateral pocket dissection.
With previously divided muscle origins in view at left, the surgeon divides pectoralis major
origins off the 4th and 5th ribs to transition from the 7 to 10 o’clock position into the lateral
portion of the right implant pocket. Dividing muscle origins slightly off the rib surfaces
optimizes hemostasis. If the surgeon cuts muscle origins flush with the ribs and intercostal
musculature, intramuscular vessels can retract, bleed, and be more difficult to control.
Clip 05: Mid pocket to lateral pocket transition
With the retractor at the 7 o’clock position of the right breast pocket, the surgeon sweeps from
medial to lateral to transition from medial to lateral pocket dissection.
Clip 06: Lateral pocket dissection
Positioning the retractor at the 9 o’clock position of the right breast pocket and twisting the
retractor tip laterally exposes the lateral border of the pectoralis minor muscle and places tension
on the lateral breast soft tissues to provide optimal exposure. The surgeon incrementally sweeps
the needlepoint electrocautery dissector tip parallel to the lateral border of the pectoralis minor to
enlarge the lateral pocket, using light, sweeping strokes to incise the tissue in small increments
for optimal control. Maintaining tension by twisting the retractor laterally places lateral
intercostals nerve branches under tension to make them more visible during lateral pocket
dissection.
Clip 07: Checking cut muscle edges for hemostasis
With the retractor in one hand, and the endoscope in the other hand, the surgeon sweeps from
medial to lateral to examine all cut edges of the pectoralis muscle for intramuscular vessels to
assure optimal hemostasis and avoid even minor bleeding that leaves blood in tissues, increasing
inflammation and patient discomfort.