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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
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Fig. 7.54
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Fig. 7.55
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16. The skin is then de-epithelialized. Injury to the subdermal plexus is
to be avoided under all circumstances! (Fig. 7.56)
17. Subsequently, a size 12 Redon suction drain is inserted on both
sides, each positioned around the centrocaudal pillar (Fig. 7.57)
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Fig. 7.56
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Fig. 7.57
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18. CoriumsuturingoftheNACwith4.0Monocrylat3,6,9,and
12 o ’clock (Fig. 7.58)
19. T wo-layer subcutaneous (Monocryl 3.0 interrupted sutures) and
intracutaneous (Monocryl 4.0 continuous) skin closure (Fig. 7.59)
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Fig. 7.58
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Fig. 7.59
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20. The wounds are protected by means of Steri-Strips (Fig. 7.60)
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Fig. 7.60
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Tips and Tricks
“Big surgeon, big incision ”: this anachronism is still around today,
although it is really not so difficult to spare women from extensive
inframammary incisions.
As we have seen over the years, the indication for the reduction/
lifting technique according to Lassus/Lejour has become ever narrower- and rightly so in our view, since the contracted skin in the
distal suture area was often for both patient and physician an insurmountable obstacle to achieving aesthetic expectations.
By pinching together the distal part of the female breast just above
the inframammary fold between the thumb and index fingen the
skilledexpertisabletoseepreciselywhichwayhemustgoduring
surgery.
Naturally , the position of the nipple-areola complex is marked while
the patient is in a standing position. Both sides caudally are marked
corresponding to the area to be resected.
And now to the above-mentioned pinch test. The trick here is to
perform this test while the patient is in a lying position. In this way ,
one is able to identify very accurately where the two distal sides
need to be joined, as well as how long the horizontal side should be:
on average between 4 and maximum 6 cm, irrespective of breast
size.
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Regardlessofthesizeofareatoberesected,bothsidesarealwaysthe
same, thus producing an aesthetically pleasing result.
Even when there is excessive folding in the case of extreme resection,
this can be easily and locally revised after 6 months on an out-patien t
basis, without having to extend the length of the horizontal suture line.
(Fig. 7.61)
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a
Fig. 7.61
b
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Results
ab
Fig. 7.62
a A37-year-old patient with ptotic breasts before the operation
b The same patient 12 months following mastopexy
ab
Fig. 7.63
a A42-year-old patient after four children before theoperation
b The same patient 12 months following mastopexy
ab
Fig. 7.64
a A47-year-old patient with ptotic breasts before the operation
b Thesamepatient12monthslaterfollowingmastopexy
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