MastopexyBy: RhettPg. 769

Physiology

● Mammary glands are located anterior to the pectoralis major muscle between the second and sixth rib, lateral to the sternum, and extend to the axilla.

● Consist of glandular tissue● 15-20 lobes with apex oriented towards the nipple.● Each lobe contains a lactiferous duct.● Nipple receive the opening of the lactiferous ducts.● Arterial/venous supply: internal thoracic, lateral mammary, and intercostals.● Lymphatic drainage is important in the breast.

Pathophysiology

● To correct breast ptosis (drooping) ● Can cause severe lower back problems and cause the “Braziers” to indent the skin,

causing chronic discomfort.

Diagnostic Exams

● History and Physical● Direct Examination

Surgical Intervention

● Correct breast ptosis by a mastopexy (anchor technique)

Special Consideration

● Skin incision and technique depends on the degree of ptosis so confirm with surgeon so you can get correct instrumentation.

● Often augmentation mammoplasty is performed at the time of the mastopexy procedure.

Anesthesia, Positioning, Skin Prep, & Draping

● General Anesthesia ● Supine● Neck to umbilicus to include both breasts and bilaterally as far as possible● Four towels to square off both breasts; transverse chest drape

Incision

● Anchor-shaped incision that starts at the base of the areola and extends at an angle vertically on both sides and upward to form the boundaries where the nipple will be relocated.

Supplies, Equipment, and Instrumentation

● Plastic instrument set● Basic back table pack● Tunneling device● Temporary implant sizers● Permanent implants● Endoscopic equipment (surgeon’s preference)● 0 degree endoscope● Transverse chest drape● #15 knife blades● Local anesthetic with epi ● Syringes and needles for local

Supplies, Equipment, and Instrumentation

● Antibiotic to be mixed with saline irrigation fluid● Syringes and saline● Syringes and saline solution to fill implants● Fiberoptic retractor set● ESU and pencil with needle tip● Marking pen● Bulb Syringe ● Dressing, including postsurgical bra

Different Techniques

4 Different kinds:

● Crescent lift: A crescent-shaped piece of tissue superior to the areola is excised and the tissue is reapproximated higher which lifts the breast.

● Benelli lift: A periareolar incision is made removing a doughnut-shaped piece of tissue is reapproximated to the areola using a purse-string suture

● Benelli-lollipop: Similar to the Benelli life, a keyhole incision is made that involves a periareolar incision that extends in a straight line from under the middle of the areola to the mammary crease.

● Anchor technique: Steps I go over; most common.

Procedural Steps

● The surgeon marks the planned incision with the marking pen on both breasts. (preop)

● Using a #15 knife blade, make previously described anchor-shaped incision. The nipple is removed and relocated when performing a full mastopexy.

● The excess dermal tissue is excised from within the borders of the incision including removal of the nipple.

● The skin is drawn together and reapproximated, lifting the breast to a new position, and the nipple repositioned. (If augmentation mammoplasty is indicated, it is now performed.)

● Fluffs are used for the dressing and a postsurgical bra is used to hold the dressings and breasts in position while healing takes place.

Counts

● Initial and final

Dressing Material & Specimen Care

● Fluffs and a postsurgical bra● No specimen care

Prognosis & Complications

● No complications: Discharged same day. Sutures will remain in place for about 10 days. Patient will need someone at home to provide care during the first 48 hours after surgery. Patient is expected to have a full recovery and return to normal activities as well as excellent cosmetic results.

● Complications: Postop SSI, stretching of scars over time due to tension, large implant, improper support during healing phase, poor tissue elasticity due to age or illness, and death.

Wound Class & Management

● The head of the bed should be slightly elevated as patient recovers from anesthesia to help in reducing swelling. Ice may be needed to reduce swelling at home.

● Class 1: Clean