Mastopexy Augmentation

Laurence T. Glickman MD FRCSC FACS
Long Island Plastic Surgical Group
Garden City New York
Breast Augmentation and Mastopexy
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Anatomy
Consultation
Operative Plan
3D Photography
Surgical Options
Augmentation
Mastopexy
Augmentation/Mastopexy
Post Operative Care
Complications
Anatomy of the Breast
Blood Supply
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Internal Mammary Artery
Lateral Thoracic Artery
Thoraco dorsal Artery
Medial and Anterolateral
intercostals
3rd - 5th anteromedial intercostal
nerves (T3-T5)
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3rd - 6th anterolateral intercostal
nerves (T3-T6)
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Supraclavicular nerves from lower
fibres of cervical plexus -->
innervation to
upper and lateral parts of breast
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Lateral cutaneous branch of 4th
intercostals (T4) --> innervation of
NAC
Indications for surgery
Breast augmentation aims to enlarge the breast
Mastopexy aims to improve the shape of the
breast and elevate the nipple areolar complex
without altering the size of the breast
Augmentation/ Mastopexy aims to improve the
shape and enlarge the breast while elevating
the nipple areolar complex
Pre Op Considerations
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General Medical History
Breast History
Date of last mammogram
Family history of breast disease and cancer
Examinations of Breasts
Size and Shape in relation of body habitus
Previous breast surgery
Motivations and expectations of surgery
Understanding the surgical options
Pre Op Measurements
Sternal notch to nipple distance
Inter-nipple distance
Asymmetry
Distance of nipple in relation to inframammary
crease
y Skin quality, breast density, chest wall size
y Areolar dimensions
y Preoperative Photographs
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Pre operative photos
3d photo analysis
Blood work
Medical Clearance
Mammogram
Ultrasound
Implant selection
Surgical approach
Informed consent
Preoperative Worksheet
Questions to Consider
How long will I be off work
How long will the stitches be in
How long for the swelling to go down
How long must I wear a special bra
Will you guarantee breast size and shape
When can I start normal activities
Will I have normal sensation in the breast and
nipples
y How much will the procedure cost
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Surgical Approaches
y Augmentation
Inframammary vs. Periareolar vs. Transaxillary
Subpectoral vs. subglandular
Saline vs. Silicone
y Mastopexy
Periareolar vs. Vertical vs. Inverted T
y Augmentation/Mastopexy
Incision and implant type
Augmentation Incisions
Choosing an Implant
y Saline vs. Silicone
y Advantages
y Disadvantages
Implant Selection
Saline Implant
Silicone vs. Saline
Breast Augmentation
Breast Augmentation
Mirror System -Vectra 3D
Vectra 3D imaging
Vectra 3D
Vectra 3D
Vectra
Vectra 3D imaging
Trans-axillary Augmentation
Trans-axillary Augmentation
Augmentation -Transaxillary
Peri-areolar Augmentation
Peri-areolar augmentation
Breast Augmentation
Breast Augmentation
Breast Augmentation
Breast Augmentation
Breast Augmentation
Breast Augmentation
Breast Augmentation
Augmentation –Peri-areolar
Augmentation – peri-areolar
Augmentation - peri-areolar
Augmentation – Transaxillary
Ptosis
Mastopexy -Surgical Options
y Benelli incision – periareolar - crescentic
y Le Jour incision – vertical – circumvertical
y Robbins incision – inverted T- Wise pattern
Every surgeon uses a different technique
Mark midline
Mark position of IMF
Measure from sternal notch to nipple and from midline to nipple to assure
symmetry
Transpose IMF to help determine NAC position (some put it at IMF, some
above)
+/- Mark new areolar opening - some leave areolar excision until the end and
do not mark it at the start
Design pedicle position and dimensions
Plan skin resection
Vertical Mastopexy
Vertical Mastopexy
Vertical mastopexy
Vertical Mastopexy Auto -Augmentation
Vertical Mastopexy
Vertical Mastopexy
Mastopexy Inverted T Breast
Markings
Mastopexy Inverted T Breast
Markings
Mastopexy Inverted T Breast
Markings
Mastopexy - Inverted T
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Mastopexy
Augmentation Mastopexy
y One of the most difficult and complicated
operations we do
y Up to 20% complication rate
y High incidence of patient dissatisfaction
y Poor communication
y Poor planning
y Poor execution
Augmentation Mastopexy
Mastopexy/Augmentation
Mastopexy/Augmentation
Mastopexy /Augmentation
Mastopexy/Augmentation
Mastopexy/Augmentation
Mastopexy/Augmentation
Mastopexy /Augmentation
Mastopexy Changes over
time
Post Operative Care
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Limit exercise for 4 weeks
Take antibiotics and analgesics as prescribed
Encourage hydration - 8 glasses of water a day
No smoking or second hand smoke
Post operative exercises
Wear brassiere 24/7 for support for 2 weeks
Wear Bandeau when indicated
Silicone sheeting post operatively for 3 months
Post Operative Exercises
Post Operative - Bandeau
Post Operative Gel
Complications
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Bleeding
Infection
Scarring
Asymmetry
Capsular Contracture
Window shading
Bottoming out
Necrosis
Nipple Insensitivity
Inability to lactate
Mammographic Changes
Peri-areolar Mastopexy
Rippling
Augmentation/Mastopexy
Bottoming Out
Hematoma
Window shading
Capsular contracture
Capsular contracture
Implant selection
Scarring
Scarring
Concluding Remarks
y Cosmetic Breast surgery is challenging
y Patients must be carefully evaluated for breast
pathology
y Patients must be carefully selected for existing
breast shape, skin quality and morphology
y Selection of implants must be made with the
patient
y Mastopexy has many surgical options
y Augmentation /Mastopexy is a very challenging
procedure
y Breast augmentation and Mastopexy can be very
rewarding with excellent outcomes
Thank you!!!