Incisionless Mastopexy: A 15-year Experience Refining A Tissue Molding Procedure
roger K. khouri, MD, Daniel Calva-Cerqueira, MD, Raul Cortes, MD.
Miami Breast Center, Key Biscayne, FL, USA.
PURPOSE:Tissues contract, plastic surgeons fight contractures. Could we turn this foe into a friend and replace tailoring procedures with controlled contractures that molds the breast? We present our 15 years-experience refining this minimally invasive procedure.
METHODS:We tightly tumesce the subdermal plane with adrenaline-saline, and with a rod-like rasp dissector inserted through circumareolar punctures, we separate skin from parenchyma using windshield-wiper-seesaw motions that induce a controlled subdermal inflammation. We then place the patient in extreme Trendelenburg to re-drape the dissected envelope in the ideal position, insert subcutaneous #2PDS clavicle-to-nipple loop sutures, and apply an external conforming adhesive bra that maintains the optimal shape and position. Patients keep the bra at all time for 8 weeks, replacing it in the office as needed. Upon final removal, the healed subcutaneous scar interface maintains the breasts in the uplifted position.
RESULTS:150 breasts had an incisionless mastopexy, and at six months follow-up, 122 breasts had no ptosis and 28 patients had partial failures from inability to maintain the adhesive bra for the required period. For the first 7 years it was unilateral to achieve symmetry with the contralateral reconstructed breast, then as our results became more predictable, we offered it to the cosmetic bilateral mastopexies. Heavier and more pendulous breasts (45%) required a second procedure to achieve optimal results. Earlier in our experience we had 3 full thickness ulcerations that healed by secondary intention and subsequent scar revisions.
CONCLUSION:Beautiful mastopexies can be simply performed by tissue molding without incisions and without visible scars.
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