 over his hair follicles look at how far lateral they are I want to move them up here so my plan is to remove this shape and put it together you can see he's very thin I like put everything out there's only thing is gonna be left is the lymphatics so here we go one two three and then we're gonna go down this way this might seem barbaric but it's the right way to do it is because you want to retain the lymphatic channels so that he doesn't get a seroma or anything so what we're doing is just pulling off the skin you could see all the good stuff look at that that's all the lymphatics is not getting cut you could see how thin it is this is only the skin that we're taking off look at all that lymphatic channel this is very good anatomy this is the axilla a lot of lymphatics in here look at all the nerves and everything is in place the only thing we're taking off is the skin and a little bit of the fat everything else is retained here so this is exactly what we want to do just take off the skin you could see it's barely holding on okay so look at what we've done we've established the lateral chest line there is his chest there's his nipple this is the lateral axillary line we put the we put his hair follicles there are the follicles up where it should be under his arm under his axilla they were down back here so we moved it we tacked it down to the chest now we're gonna sew it up sew up his arm and then go to the next step stay tuned so look at the area of skin we're taking out stretched out it's very long when it's gone it when it's let go and it's steady state it's pretty small but when you stretch it out look at how long that is we're taking a good amount of skin so again we're going right there so again we're just lifting the skin we don't want to take the the lymphatics or the veins from underneath so we're just going to pull the skin off okay I want you guys to see the inside look at all these thin vessels here some of them are nerves some of them are lymphatics that's his bicep muscle you could see everything and now we're going to just pull off the excess tissue and there we are so you could see with us doing the lipo you could see we've taken out all the fat we've left all the important structures we haven't violated the muscle or anything look at what a big slice of skin we've taken out now we can approximate it and put them together so you can see how we're going to recruit the hair follicle the area from his from his back into his axilla where it should be and I'm just going to mark go to the markings and approximate them as such