Breast Augmentation Surgery – Transaxillary Surgery Using a Keller Funnel, Hawaii with S. Larry Schlesinger, MD, FACS at The Breast Implant Center of Hawaii, serving Oahu and Kona.
Video Transcript:
“Ok Jessica, we are all ready to go. You can give hugs and kisses on your way out. And Steve we’ll call you as soon as we’re all finished, ok?”
“Walk on in, and just kind of veer to your left there.”
“This doesn’t put you off to sleep this just makes you feel good.”
“Table up. And we do the inframammary and the lateral area where the intercostal nerves come up. Then we use the curved Metzenbaum scissors to open into the axilla and then now that we’ve made our initial incision nothing else sharp goes inside of Jessica. This is all blunt dissection.”
“See we got Pec Major right here. There’s a fascial plane between the two and it means that when you get into it it’s a soft plane. You know you’re not tearing any fibers. We’re in it right now. I’m above the Pec Minor, below the Pec Major and this is a dissector. The dissector goes in, it creates the space. Open it widely but do not interfere with the insertion of the Pectoralis Major into the fifth rib which occurs about this level right here.”
“Now we’re going to put an endoscope in and we’re going to cut the Pectoralis Major off the fifth rib. This causes no loss in function of the Pectoralis Major. A lot of studies have been done on that this is not going to interfere with pushups, decline bench pressing or anything else.”
“Amacar is a medicine that helps decrease bleeding. Makes these surgeries very nice. Ok, now we’re going to put the sizer in, mimic what an actual implant will look like and we fill it up with saline and see what size looks best. These go in sixty cc increments. That’s sixty, one-twenty, one-eighty, three-hundred. You can see it’s not quite going down to where we want it. Four-twenty, little bit more at the bottom. Five-forty and here’s the extra ten, five-fifty. Five-forty and ten is five-fifty. So we’ll work from that point.”
“Ok, now at this point we’re going to sit the patient up and we’re going to look and see what she looks like in the standing or sitting up position so we know that the implants are in the right location. We want to bring this down right here and I’ll attempt to do it right now. There we go, pretty good.”
“Alright, now we’re going to lavage out the pockets, clean them out so that we can have pretty good chance that they’ll be no post operative bleeding. So we’ll put a drain in to decrease the chance of blood around the implant. And this is a five-fifty cc implant going in through a transaxillary approach. It never touches the skin. And there it is. Perfect. And here’s another Keller Funnel and there is the little area we want on the back that’s why we put it in with this going down. A little air got in there with the implant. And now you can see that this needs to be open a little bit to the side. So we don’t open it to the side until the last minute.”
“Ok, we’re going to put the drains in now. You always have to have a drain. If you don’t have a drain you will have blood around the implant and that will lead ultimately to potentially a hard breast. The first layer of closure is with a 4-0 Monocryl and this is called a subcuticular suture below the skin and these last about thirty days. They give us enough strength to keep things together until scar tissue can take over again, there’s no tension here so literally the patients can lift there arms up right after surgery. They may not want to but they can.”
“Then we do a running intradermal with Prolene. Pulls out very nicely at six days. And this stitch is a running intradermal stitch. This could be left in several weeks because it doesn’t leave any cross hatch marks however, I believe in taking it out at six days so people can put on deodorant and shave and things like that.”
“I put in some interrupted black nylon sutures and the reason I do that is I’m kind of a belt and suspenders sorta guy. I want to make sure that everything stays exactly where I put it.”
“Everything looks good.”
“I think she’ll love it.”
“Definitely.”
“Yeah and we’ve got it all done. So, she’ll probably be about an hour and a half before you’ll be able to go talk to her, she’ll be awake and going home. Make sure they give you some DMSO I’ll talk to them. Because sometimes you get bruises below and you’ve got to spray those bruises. Do it every hour and they’ll be no bruising in the morning.”
“Ok.”
“And if I don’t see you before you leave, I’ll see you at 6:30 tomorrow morning.”
“Thank you.”