In part one, S. Larry Schlesinger, MD, FACS explained the steps of the breast augmentation surgery, he removed the original implant, cut and raised the capsule and sized the lift. Now that the capsule is raised to the correct level, it’s time to reinforce the capsule with Seri, replace the implant, and then stitch her up.
So we’re using Seri scaffolding to augment the bottom and the side. Augment the lift and the lateral lift. And what we do is we take it and we’re going to have a piece that goes this way and a piece that goes that way. The Seri scaffolding is made out of silk, raw silk from silkworms so it’s considered biologic and it lasts about 28 months. It takes a long time to go away. In the meantime, it’s replaced by scar.
And now we just put a little Seri here and we’re good. So we’re imbricating the capsule here. We’re sewing it on itself and we use the Seri more for the stability because we can’t sew into the ribs too well here because unfortunately the capsule is very thin and if we sew into the ribs too well, what will happen often is she will be in a lot of pain continuously.
OK, time for Seri. Let’ overlap here at the corner. Now we’re anchoring it to the lowest possible point. OK, so here it is on the ribs. Here it is up the sidewall. We sew those in after we get the implant in. Back down…perfect, right there.
We’re diluting all the bad bacteria out…one more…there. Drain. Alright, now that looks wonderful. See the pectoralis muscle comes right down there. And so what we’re going to do is we’re going to move it back a little bit, so if this all gets scarred in…you probably haven’t seen this before but patients complain that every time they flex their muscles it indents their nipple so we grab the muscle there, and we just release it right under the fascia or on top of the fascia and we move it back just a little bit and then it will no longer be in a position to be bound down. So any indenting you see up there will vanish when this stitch dissolves which is about six months. Also, we don’t grab the muscle. Just grabbing deep tissue.
