Mastopexy - Mastopexy Procedures

Mastopexy Procedures

Pre-operative matters

The plastic surgeon delineates the mastopexy incision-plan upon the patient’s breasts and torso; the principal corrective consideration is the correct level of the nipple-areola complex upon the breast hemisphere. In most women, the nipple should be located at, or slightly above, the inframammary fold, because emplacing it too high might later lead to a difficult revision surgery. The proper topographic locale for the nipple is determined by transposing the semicircular line of the inframammary fold to the face of the breast (anterior aspect), thereby configuring a circle, wherein the nipple-areola complex is centred. After determining the nipple locale, the surgeon delineates the remaining skin incisions of the correction, while maintaining the inferior limit of the vertical-incision at a distance above the pre-operative inframammary-fold, which precaution avoids extending the surgical scar to the chest wall after the lifting of the breast and the inframammary fold.

Intra-operative matters

The sole application of breast augmentation mammoplasty to correct minimal breast ptosis (Grade I) usually is effected with a breast implant prosthesis. The dual application of mastopexy and of breast augmentation surgeries — as one surgical procedure — requires thorough planning, because of the required resections of the parenchymal tissues. The periareolar incision lends itself to breast prosthesis implantation and to nipple-areola complex transposition, whilst maintaining the tissue viability of the nipple-areola complex.

Mastopexy by internal surgical approach applies to the woman who has undergone explantation of breast prostheses. In operative praxis, the plastic surgeon elevates the flaps of the cut breast-implant capsules, and folds them in order to increase the volume of the internal mass of the breasts — thereby increasing the projection of the bust from the chest surface. The nipple-areola complex is elevated with plication sutures, and requires no skin resection when there is no excess skin.

Pedicles — superior, inferior, and medial

Although the aforementioned descriptions are of the incisions used to address the breast skin envelope, the surgical management of the breast tissue (parenchyma) is a separate consideration, including maintenance of the neurovascular integrity of the nipple-areola complex. The degree of hemispheric elevation of the nipple-areola complex determines the type of pedicle (superior, inferior, medial) that will provide the best venous and arterial vascular supply to the nipple-areola complex. Therefore, the application of the superior pedicle approach affords the surgeon greater procedural flexibility in determining the incision site for emplacing the breast implant, but it limits the possible degree of elevation of the nipple. Application of the inferior pedicle approach affords a greater degree of nipple-areola complex elevation, but makes difficult emplacing the breast implant, and the subsequent contouring of the breast. Application of the medial pedicle approach preserves breast sensation with a reliable venous and arterial vascular supply, and avoids the technical and procedural limitations of the superior pedicle and the inferior pedicle approaches.

Post-operative matters After the breast-lift surgery, wound care is minimal when the sutured closure is subcuticular (under the epidermis), and reinforced with strips of absorbable adhesive tape (butterfly stitches) applied to maintain the wound closed.

Post-operative surgery scars upon the breast hemisphere can alter the way that the woman conducts her breast self-examination for cancerous changes to the tissues; thus exists the possibility that masses of necrotic fat might be mistakenly palpated as neoplasm lumps; or might be detected as such in the woman’s scheduled mammogram examinations; nonetheless, such benign histologic changes usually are distinguishable from malignant neoplasms.

Complications

General medical complications of mastopexy include bleeding, infection, and the secondary effects of the anaesthesia. Specific complications include skin necrosis, and dysesthesia, abnormal changes in sensation (numbness and tingling). Serious medical complications include occurrences of seroma, a pocket of locally accumulated serous fluid, and occurrences of hematoma, a local accumulation of blood outside the vascular system. Necrosis of the nipple and necrosis of the skin flap (or both), when it occurs, can either be partial, and heal imperceptibly with wound care, or can be complete, and necessitate reconstruction. A complication of the Anchor mastopexy is the tension-caused wound breakdown at the junction of the three limbs of the incision, yet the scars usually heal without undergoing hypertrophy. Asymmetry of the bust is usually present pre-operatively, and the breast-lift surgery usually does not definitively eliminate it, regardless of the applied mastopexy technique or of the plastic surgeon’s operative expertise. Moreover, a combined mastopexy–breast augmentation procedure can make the surgical revision of breast asymmetry more difficult because of the overstretched tissues of nipple-areola complex. Moreover, a possible, undesirable outcome of the periareolar mastopexy (circumareolar incision) is the underprojection of the corrected breast from the chest wall.