Case 38 Mastopexy/Augmentation



Rachel R. Sullivan

Case 38 Mastopexy/Augmentation

Case 38 A 49-year-old female with chief complaint of loose skin and volume loss of the breasts after massive weight loss.



38.1 Description




  • Patient with severe deflation of bilateral breasts and grade 3 ptosis



  • Breasts appear to have a very long sternal notch to nipple-areola complex (NAC) distance



  • Notable sagging and laxity of skin



38.2 Work-Up



38.2.1 History




  • Determine patient’s motivation for seeking surgery and desired result: Breast lift, increased volume, correction of asymmetry, or a combination



  • Prior history of breast or thoracic procedures: May impact blood flow



  • Identify and discuss comorbidities that may affect healing (e.g., diabetes, cardiopulmonary disease)



  • Smoking history



  • Personal risk/family history of breast cancer and prior mammography



  • Pregnancy and breastfeeding history, and plans for future pregnancy



  • Current breast size and desired breast size



38.2.2 Physical Examination




  • Systematic evaluation of the breast (Fig. 36.1, Table 36.1)




    • Relationship of nipple to inframammary fold (IMF)



    • Relationship of breast tissue to IMF



    • Overall size and surface area of the breast



    • Quality of skin (elasticity, thickness, striae) and breast parenchyma



    • Breast and/or chest wall asymmetries



    • Palpate for masses and/or nipple discharge



    • Assess nipple–areola complex (NAC) sensation



  • Key measurements




    • Sternal notch to nipple distance, nipple to IMF during stretch, breast base width, superior and inferior pole pinch thickness, anterior pull skin stretch, and estimated parenchymal fill



  • Preoperative photographic documentation



38.3 Patient Counseling




  • Discussion of patient’s expectations versus anticipated outcomes



  • Possible complications and/or recurrence of ptosis



  • Potential need for revisions and how revision costs may be handled



  • Implant type




    • Saline versus silicone (see Table 38.1 for comparisons)



    • Round versus shaped



    • Smooth versus textured



    • Discuss Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) (see chapter 35)



  • Implant placement (subglandular, subpectoral, dual plane)



  • Possible negative effects on future breastfeeding



  • Postoperative breast cancer surveillance



  • Expected postoperative course and return to function



  • Possible use of drains, postoperative garments, and instructions




    • Postoperative activity and return to work

























      Table 38.1 Comparison between saline and silicone implants
       

      Pros


      Cons


      Saline


      Easily adjustable size


      Low contracture rates


      Rupture identified clinically


      Rippling


      Less natural feel


      Silicone


      More natural feel


      Lighter weight than saline


      Lower notable rippling


      Higher contracture rates


      Larger incisions for placement


      MRI necessary to evaluate for rupture


      Abbreviation: MRI, magnetic resonance imaging.

       

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 38 Mastopexy/Augmentation
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