title: Redo submammary incision for median sternotomy and cardiac repair.
abstract: BACKGROUND
  Minimally invasive and cosmetically attractive approaches are fashionable in conducting cardiac operations.
  
  
  METHODS
  We reviewed retrospectively our experience in patients undergoing cardiac operations by means of redo submammary incisions.
  
  
  RESULTS
  Fifteen consecutive female patients with a mean age of 13.2 years (range, 0.7 to 44 years) underwent reoperation through a former submammary incision. Seventy-three percent (11 of 15) had median sternotomy, cardiopulmonary bypass, and cardiac repairs. The mean aortic cross-clamp and cardiopulmonary bypass times were 78 +/- 49.7 minutes (range, 16 to 182 minutes) and 114.4 +/- 66.4 minutes (range, 27 to 261 minutes), respectively. Twenty-seven percent (4 of 15) had off-pump procedures; 3 for pacemaker-related issues (1 a third time reentry) and 1 for removal of sternal wires. Mean time interval between the primary submammary incision and reoperation was 5.4 +/- 5.6 years (range, 0.01 to 20 years). Mean first 24 hours Hemovac drainage was 3.2 +/- 2.4 mL/kg (range, 0.4 to 8.5 mL/kg). Mean intensive care unit and hospital stays were 2.1 +/- 1.7 days (range, 0.0 to 5 days) and 5.5 +/- 3.6 days (range, 0.80 to 13 days), respectively. One patient exhibited a chylothorax requiring ligation of her thoracic duct. Another patient had an infected seroma requiring incision and drainage 2 months postoperatively. Skin necrosis and infection were absent in this group. Breast development and lactation were normal. The cosmetic results were satisfactory. There was no mortality.
  
  
  CONCLUSIONS
  Redo sternotomies performed through redo transverse submammary incisions are safe for cardiac repair and result in acceptable cosmetic and functional results.
authors.affiliation: Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1741, USA. jodim@mednet.ucla.edu
authors.forename: Jonah
authors.initials: J
authors.lastname: Odim
authors.forename: Raj
authors.initials: R
authors.lastname: Vyas
authors.forename: Hillel
authors.initials: H
authors.lastname: Laks
authors.forename: Azie
authors.initials: A
authors.lastname: Alikhani
authors.forename: Umang
authors.initials: U
authors.lastname: Mehta
authors.forename: Kakra
authors.initials: K
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D000328:Adult; D001940:Breast / Q000254:growth & development; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000209:etiology; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007774:Lactation; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012086:Reoperation; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing