(a) Intraoperative photograph showing Wise pattern incisions with de-epithelialization of the skin. The area in yellow will be resected as part of the Type IV SSM. This excision leaves a rim of dermis along the vertical limbs of the skin excision. (b) The inferior skin flap is elevated down to the inframammary fold. (c) The de-epithelialized inferior skin flap is draped over the tissue expander and sutured to the released inferior border of the pectoralis major muscle. Back cuts are made to allow inset of the dermal flap. (d) The skin flaps just prior to closure. The de-epithelialized vertical limbs serve as a buttress. (e) Preoperative appearance. (f) Postoperative appearance after type IV SSM and implant reconstruction using an inferior dermal flap.
