REVISIONARY SURGERY using a purse string breast lift with implant change for capsular contracture and prosthesis rotational problems

 Background
 Patient Groups
 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)

THE OPERATION
Surgery for breast lift can take 2 and one half to 5 hours and for insertion of implants can take 3 and one half to 5 and one half hours. Anesthesia is a general method whereby a tube is either inserted into the back of the throat only or into the airway itself. Intravenous fluids are administered as well as medications for comfort, infection control, and relaxation of the chest muscles when indicated.

4 key landmarks are joined in a tear configuration so that all surgery is performed within the perimeter of this design to permit closure in a circle by cinching the purse string. The outer dotted area is when a purse string lift without implants is planned. The inner dotted area denotes a smaller skin reduction when a purse string lift with implants is planned.
The yellow and violet pattern is the breast tissue that is assembled into a new internal brassiere. Any implants can be inserted or replaced behind the breast or muscle before this action. The nipple is moved upward with the gland as the internal bra is fashioned so the new breast will be situated higher on the chest. For a purse string lift with implants, the nipple may not require significant elevation. For a purse string lift without implants the nipple can be raised considerably.
After the internal bra is fashioned, the breast is suspended to the chest, and the skin is closed by cinching the purse string suture to form a circular scar around each areola. The nature of the purse string cinch will be to create some necessary early pleating which subsides over time. The white vertical lines enclosing the red pattern on the left breast (marked by the light blue arrows) represent the vertical and t scar method of skin closure for extreme forms of sagging and long breasts.
The purse string will close each areola into a circle illustrated in blue. The purse string breast lift closure is now represented by the blue circle around the areola. The vertical and horizontal white lines on the left breast represent the vertical and t scar method of skin closure, respectively.