Dr. Thomas Trevisani, Sr.: This patient is a young woman, under 30 years of age, who's had one pregnancy. But that one pregnancy, because she breastfed, left her with an enormous excess of skin for the volume of her breasts. When you look at a breast that you believe to look its best, we know that the distance from the Sternal Notch, which is where the collar bones join in the middle of the body, to the nipple, somewhere between 20 to 22, no more than 23 centimeters. Her distance from her Sternal Notch to her nipple was well over 30 centimeters; I think it was 33 or 34 centimeters. So we moved her nipple 12 centimeters or so from where it was to where it will be.

Prior to the day of surgery, we've seen the patient at least twice, oftentimes more. We've reviewed risks and benefits and all the potential complications in going through a very extensive educational process for the patient, regarding her particular specific procedure.

Knock, knock.

Female voice: Please come in.

Dr. Thomas Trevisani, Sr.: May we come in.

Female voice: Yeah.

Dr. Thomas Trevisani, Sr.: On the day of surgery, we see her in the preoperative holding area, where any last minute questions are addressed. And I usually have the patient stand up with the nurse in attendance, and I go through the markings and the exact measurements and drawings that need to be done, in order to guide us during the operative procedure. Once I make those measurements, draw the midline, find the midclavicular line, drop the breast meridian, measure where the new nipple's going to be. And this is an interesting process to determine where will the new nipple be. The mid-humerus, the mid-upper arm can correlate to where the new nipple areolar position should be; that's one method. With their shoulders back, feet together, have them lift their arms straight up to the sky, straight up to the ceiling. And that gives us an indication, compared to where the nipple position was with the arms at their sides, to where it's going to be.

Then I estimate where those two positions are, and then measure it with our previous dimension. And almost always, it comes out to be exactly where it's supposed to be.

Dr. Thomas Trevisani, Sr.: Then what I do at this point is inject the area with a local anesthesia that's long-lasting, in conjunction with a vasal constrictive agent. This gives us an opportunity to then have the patient free of pain upon awakening, and also give us a minimal bleeding during surgery. I usually interact with the woman preoperatively to determine how large areola, which is the brown skin around the nipple, she would like to have.

We're using a 50-millimeter diameter. So we have a variety of areolar templates that we use to give us a perfect, circular areolar dimension and an incision site.

What I like to do is make the circumareolar incision to basically embed, engrave that site. Now it's done; we've made a commitment at that point, for that's our new areolar size. Once the circumareolar incision is made, and I follow the template and I mark that distance of where the new triangulation point will be. And once we make the incisions for the right and left medial lateral limbs, and then carry the incision along the inframammary site, we now are committed to the new breast shape.

At this point, it doesn't look like much, but once we proceed with the skin excision, and then we can bring those three points together. There is the medial and lateral junction of the upper and lower limbs of the incision site, which then will be joined the midline meridian in the bottom of the breasts - in the inframammary crease. That will then give us the new shape.

Once the extra skin has been removed and we've done the triangulation stitch, we brought in the medial limb to the lateral limb, and joined it to the inframammary crease, that gives us the new shape. Now, our job is to close these incisions. So we have the bottom lateral portion of the T, we have the bottom medial portion of the T, we close that. Then the vertical component, and the last thing is to exteriorize the nipple areolar complex. That's the next, the last step. So if there's any need for a final adjustment, this is our last chance to adjust the final position of the nipple areolar complex, as it appears on the new breast mound.

Putting sutures through the skin surface can potentially leave suture marks. What we do is use deep sutures to remove the tension from the final skin closure. Those are all absorbable sutures. Once that's done, then we augment that closure and further remove tension on the incision with Steri-strips; most plastic surgeons use Steri-strips. The goal of all surgical wound closures is to optimize the body's own mechanism to heal it closed.


Breast Lift Performed For Woman With Sagging Breasts After First Child

Dr. Thomas Trevisani explains his pre--op procedure for mapping a breast lift before providing a walk-through of the actual surgery and details pertaining to the recovery period.