Toronto: Breast augmentation combined with mastopexy can yield long-lasting results depending on the technique that is used, explains a plastic surgeon here. Speaking at the annual meeting of the Canadian Society for Aesthetic (Cosmetic) Plastic Surgery (CSAPS), Brian Peterson, M.D., a plastic surgeon based in Kelowna, British Columbia, Canada, and a clinical instructor in the department of plastic surgery and faculty of medicine at the University of British Columbia in Okanagan, British Columbia, describes how he performs the procedure to correct sagging breasts and give breasts a more youthful appearance. SHAPE AND POSITION "The augmentation is to enhance the shape and fullness of the breast, and the mastopexy is to reposition the nipple-areola complex to a more elevated and youthful position on the breast," explains Dr. Peterson, current CSAPS president. "The women who want this procedure have breasts that are saggier than they would like," Dr. Peterson explains. "The reason this happens is that the breast is primarily made up of fat and breast tissue. It has internal support. With time, you end up with sagging breasts."OPTIMIZING THE STANDARD With the standard operation, Dr. Peterson says that the skin envelope that holds the breast tissue in place is tightened, but that the procedure is a temporary fix and that gravity has a downward pulling effect. "With gravity, the breast will sag over time," he says. "The tissue would be sagging off of the implant in five years. If we just augmented the breasts, they would end up bigger and saggier in the long term. I don't think that is the appearance that women desire." In Dr. Peterson's operation, he places saline implants underneath the pectoralis muscles. During the breast lift component, he removes a moderate amount of breast tissue when elevating the nipple-areola complex. The glandular tissue that is being resected would sag in the future, so this technique avoids potential sagging, giving a more youthful result in the long term, Dr. Peterson says. To perform this procedure, he makes a longer incision around the nipple-areola complex, which results in a greater scar running around the nipple-areola complex and running vertically down the lower pole of the breast, likening the scar to that which appears in breast reduction. Surgeons would choose an implant size in keeping with the amount of breast tissue that is being resected, Dr. Peterson explains. "If you see someone pre-operatively and plan to take off 100g to 150g of breast tissue, I would then use an implant that is 150 cc's larger than what we initially size for the patient," Dr. Peterson says. The technique is not difficult to perform for surgeons who regularly perform breast augmentation, according to Dr. Peterson. "There are no more challenges to this than in learning any other new procedure," he says. "There is a learning curve to any new technique." TECHNIQUE TRADE-OFFS He estimates recovery at approximately 10 days compared to two to three days for a standard procedure. He adds that it takes up to a year for the scar to fade with his procedure. "You do see a more visible scar with this procedure. There is a more limited incision with a standard breast augmentation. However, the results that are achieved are more consistent," he says. In terms of general contraindications, heavy smokers are excluded as surgical candidates. Dr. Peterson notes that any operation that is done on the breast can affect nipple sensitivity, but that in the vast majority of instances, the sensitivity is recovered over time. "If nipple sensitivity is an important aspect of the patients' sexual life, and it would be greatly affected if they didn't have that sensitivity, then doing an operation would be something to re-think," he notes. SUPPLEMENTARY PAIN DATA On an adjunctive note, in a prospective series of breast augmentation cases published in Plastic Surgery in 2004 by Dr. Peterson and his colleagues, the investigators found that there was a trend to less postoperative pain and less time spent recovering with the use of ketorolac and bupivacaine compared to ketorolac alone or bupivacaine alone in 100 patients who underwent retropectoral breast augmentation.
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