Endoscopic assisted mastopexy

Abstract

An endoscopic assisted mastopexy, with or without augmentation, or an endoscopic assisted reduction mammoplasty is disclosed in which an incision is made at a point on the body remote from the breast which is not ordinarily visible, such as in a preexisting scar, under an armpit or elsewhere accessible to the upper hemisphere of the breast. In the mastopexy with augmentation, dissection is carried up to the fascia of the pectoralis muscle and above the fascia and with the scope for visualization, an endotube is inserted from the incision over the pectoral fascia. A tissue expander is inserted and inflated to dissect the fascia away from the muscle to form a posterior pocket and then removed. With blind dissection, with external palpation, using scissors, from the incision, the skin is undermined in the upper quadrant. The pocket is then connected from the subcutaneous position and the breast tissue is released by cutting loose to yield a direct communication from the subcutaneous pocket around to the postglandular pocket. The soft tissue of the breast is elevated away from the pectoralis muscle and fascia going up above the second rib and just below the clavicle to lift and position the nipple areolar complex. The upper pole of the breast is sutured into the prepectoral fascia. An implant is placed into the pocket and then inflated with saline as in an endoscopic augmentation. The initial incision is closed and the patient is dressed and provided with support during recuperation and healing. Nipple reduction, if necessary, is accomplished by undermining the areolar border and placing a permanent circum-aroelar suture through stab wounds which allows a reduction in nipple size by the purse-string suture without any scars around the nipple. In the mastopexy without augmentation, the implant is omitted. In the reduction mammoplasty, breast tissue is removed and the breast repositioned and reshaped.