48. Mastopexy of drooping breasts with silicone implants, by means of two tiny incisions and elastic threads
KEYWORDS: Elastic Masthopexy, Mastopexy of breasts with implants, threads mastopexy, Elasticum suture
Today, the appearance of breasts that have silicone implants can be improved through a single 8 mm incision in the areolar margin. Simply by encircling the areola with an elastic thread, which is mounted on a two-tipped Jano needle, we can conize the breast, reposition the implant in contact with the chest wall, reduce the diameter of the areola or make it symmetrical, and lift the breast by a few centimeters. By means of a second, 5 mm long, incision in the axillary column, mastopexy of breasts with silicone implants can also be carried out.
Let's watch the procedure. A circle is drawn at a distance of 6 mm – 8 mm from the nipple. The areolar margin is marked out. An 8 mm wide subcutaneous tunnel is drawn, up to the conizing circle.
A dilute anesthetic solution is injected superficially along the pre-operatively drawn lines.
The 8 mm skin incision is made and a subcutaneous tunnel is created at a depth of 5 mm; this extends slightly beyond the conizing circle. A spreader is first inserted into the tunnel, followed by the two-tipped Jano needle, which partially emerges on the line of the conizing circle. When 5 mm of the tip remains in the tissues, the two-tipped needle is rotated so that the anterior tip becomes posterior, and the needle continues its pathway along the line drawn. The elastic thread is always pulled through and placed under tension. When the Jano needle reaches the tunnel, it is partially extracted until 5 mm of the tip remains in the tissues. The spreader is again inserted into the tunnel and, under its guidance, the two-tipped needle emerges from the small incision. When the elastic threads are placed under tension and knotted, they press the implant against the chest wall and conize the breast, giving it a more natural appearance.
The second thread is now implanted. This is positioned at a distance of about 1.5 cm, so as to conize the apex of the breast.
Through a second incision of 2 mm at the level of the anterior axillary line, elastic mastopexy is performed; this corrects the so-called "ball-in-a-sock" appearance.
The elliptical pathway of the thread that will lift the breast is drawn out. The design starts from the line that separates the skin of the breast from that of the chest, surrounds the breast and passes through the most prominent point of the antero-inferior quadrant. A dilute local anesthetic is applied along this new design.
A 2 mm incision is made, and a Klemmer is used to create a cavity to house the knot. The Jano needle anchors the elastic thread to the subcutaneous tissues of the bordering thoracic skin. It then continues along its pathway and emerges from the small incision. The two ends of the elastic thread are placed under traction and knotted. The breast is lifted. The tiny incision is sutured. The procedure is over.
The patient should wear a conizing bra for two or three months; in the first few weeks, this should also be worn during the night. Over a two-month period, the elastic thread is transformed into a "ligament", making the result stable.
This ambulatory Elastic Plastic Surgery procedure can be used both to give normal breasts a more natural look and to correct the so-called “ball-in-a-sock" appearance of larger breasts.
Capurro S. (2020): Mastopexy of drooping breasts with silicone implants, by means of two tiny incisions and elastic threads. CRPUB Medical Video Journal. Elastic Plastic Surgery section, www.crpub.org.
Are there any risks in using the Jano needle in breasts with silicone implants?
We normally implant the conizing elastic threads at a depth of ½ cm and the peri-areolar thread at a depth of 1 cm. In this patient, we performed conization at a depth of 1 cm.
We have never had any problems regarding the silicone implant or vascular issues.
Do you also operate on non-drooping breasts that have undergone additive mastoplasty?
Yes, we often perform conization in order to eliminate the artificial appearance created by the implant. In this way, the breasts become pointed and the anterior portion is more mobile and natural. After conisation, the areola does not widen and the subareolar tissues do not atrophy.
Is the elastic suspension thread fixed to the subcutaneous tissue of the chest?
Yes. The Elasticum EP4 (Korpo, Italy) elastic thread is fixed to the subcutaneous tissue of the chest exactly at the point where the chest skin meets the breast skin. The structure of the subcutaneous tissues of the chest is suitable for suspension, as indeed are the subcutaneous tissues of the breast.
Is the operation painful?
Our patients have never complained of feeling pain. Moreover, if the patient wears a supporting bra, the suspension thread is not under tension and causes no discomfort. In a few weeks the elastic threads are colonized by the connective tissue cells.
Can this innovative Elastic Plastic Surgery procedure also prevent drooping of the breasts?
Yes. The new conizing and suspensive "ligaments" prevent stretching of the skin and drooping.
What are the results like?
The results of conization are excellent. The breasts look natural and do not seem to have been operated on. The results of lifting are also very good. If the breasts present severe drooping, we have to assess whether the additive mastoplasty was performed properly, and whether the implants were chosen and positioned in accordance with the classic canons of beauty. However, after implantation of the elastic threads, it is still possible to correct the result of an imperfect mastoplasty procedure, if necessary, by moving the areola, so as to obtain a more pleasing result.
Some surgeons think that it is not possible to permanently lift the breasts with threads.
The dr. Capurro loves to destroy preconceived ideas. He did it with phlebology and in this section with cosmetic surgery. Fifth, we invite these surgeons to learn more.
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