Cosmetic Surgery Magazine-Invisible Scar Breast Lift
Hawaiian plastic surgeon S. Larry Schlesinger, MD, FACS explains to Jodi Thiessen the benefits of the Benelli Mastopexy (breast lift) Schlesinger modification.
Traditional breast lift will lift a droopy breast, but can leave behind up to 9cm of scarring per breast. The Benelli Mastopexy technique was first described in 1949 and popularized in the 1980s by French plastic surgeon Dr Louis Benelli.
In this procedure, the scar is only around the nipple. Hawaii plastic surgeon S. Larry Schlesinger, MD, FACS often combines it with an implant. This particular type of lift is successful with first and second degree ptosis (droop); a standard mastopexy is needed for third degree ptosis.
A general way to test the amount of ptosis is by placing a piece of paper under the breast and letting the breast hang. First degree ptosis will show breast tissue drooping over the paper; second degree ptosis is when the nipple hangs slightly over the paper; and third degree ptosis is when the nipple is more than 2cm below the paper.
The Benelli Mastopexy with implants corrects all four of these problems.
“The procedure is done by drawing an outer circle – the top of which is determined by where the new position of the nipple aerolar complex will be,” explained S. Larry Schlesinger, MD, FACS. “The bottom of the outer circle is anywhere from 5-8 cm from the infra mammary fold (breast fold). Then an inner circle is drawn by using a 38-45mm size cookie cutter as outline.”
The key to achieving the correct shape and position for the patient is by testing the outcome before actually cutting the skin. S. Larry Schlesinger, MD, FACS does this once the patient is asleep on the operating table. “Once the patient is asleep, I suture the outer circle down to the inner circle and pull it up like a purse string without cutting the skin. Then I sit the patient up and check it is the right lift, and the new position of the nipple is where you want it to be.”
When the new position is established using this technique th( incisions are made. “I cut around the nipple areolar complex ano around the outer circle and remove the skin between the two circles,” explained S. Larry Schlesinger, MD, FACS. “I leave the breast tissue with the nipple areolar complex completely intact, sitting where it was, and I loosen the skin all around it. Then I go straight down beneath the muscle and put the implant sizer in. Because the size of the implant will determine where the nipple will sit, this is another way of checking before a permanent implant is inserted. Then I take the sizer out and put a permanent implant in.
“By putting the permanent suture in, the tissue is held in place, so the scar doesn’t spread and the areolar complex doesn’t spread,” said S. Larry Schlesinger, MD, FACS. When the two circles are joined together, the nipple has moved to a higher position.
The procedure takes approximately 2.5 hours; the sutures are removed in five days. Patients are normally back at work in one week, able to swim again in two weeks and back to rigorous exercise in four weeks.
S. Larry Schlesinger, MD, FACS concluded: “With this method I can attain the shape patients are looking for, with minimal scarring.”
The four basic problems droppy breast have are:
- The areola/nipple complex is too low on the mound.
- The areola/nipple is often too large.
- The breast is hanging off the chest wall.
- There is no fullness in the upper quadrant.