Breast Reconstruction/Difficult Cases

 Background
 Classfication Of Reonstruction Cases
 Patient Concerns and Planning
 Preparing for Surgery
 The Operation
 Recovery
 At Home
 Office Visits and Follow-up
 Outcome and Complications
 Case Histories (Before and After)

OUTCOME AND COMPLICATIONS
A range of 4 to 9 cm of nipple elevation can be performed with this purse string method of mastopexy for revisionary breast surgery making it suitable for more extreme cases that otherwise would be treated with a vertical scar or T scar method. In its original inception, the circular scar breast lift was restricted to ptosis or downward nipple malposition where nipple elevation would be 1-4 cm at most. Ptosis that requires an average of 5.5 cm of nipple elevation in the more moderate degrees of breast sag can be achieved with the purse string method of mastopexy with implants. Ptosis that requires an average of 6.5 cm of nipple elevation can be achieved with the purse string method when no implants are required... Patients with the most elastic and stretchy thin skin can experience recurrence of breast droop or widening of scars, but they represent a very small subset of cases in this experience. Bottoming-out, which is more characteristic of certain results with other methods, is not ordinarily seen with the purse string breast lift. A boxy square-shape is also very rarely seen with the purse string mastopexy. The near final shape of the mastopexy with and without implants comes into play at about 6 weeks from surgery. Continued improvement prevails out to a year. Some flattening of the central breast will even out rapidly after the first week and look great by six weeks. A more rounded tear-drop breast can result but the most projecting breasts are observed in patients who are younger, have thick elastic skin, and larger central breast cones before operation. Patients who are heavy, have fatty breasts, extreme droop, and may have certain medical problems, as well as smokers, can enjoy the benefits of this operation being candidates for selection with special attention to details. Patients with mastectomy- reconstruction using a skin sparing circular central closure or periareolar lift repair, may experience additional skin and areolar draping changes including stretchy skin, and pleats.

The incidence of major complications in the series of purse string breast reconstruction operations for the past 15 years has been very low. The surgery is more complex when revisionary surgery is undertaken. Minor annoyances of suture irritation, slight scarring, persistence of pleats around the purse string scar, and need to remove the purse string suture under local anesthesia, can occur, but are well tolerated by patients. Slight distension of the areolae may occur with a purse string method of skin closure. Major infection, delayed healing, and re-hospitalization for problems are exceedingly rare.