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 40-year-old patient with deflation of a textured, saline implant in her right breast with bilateral capsular contracture (1a, left) before and (1b, right) three months after replacement of 420 cc saline implants with 550 cc silicone implants, capsulectomy and Helium Balloon mastopexy. Same patient (supine) with outline of right breast skin resection (2a, left) and (2b, right) stapled breast after placement of saline-filled implant. (ALL PHOTOS CREDIT: EDWARD PECHTER, M.D.) |
One such innovation was developed by Edward Pechter, M.D., assistant clinical professor, Division of Plastic Surgery, University of California, Los Angeles, and in private practice in Valencia, Calif. He calls it the Helium Balloon (HB) approach, both for the allusion to the elevation of the breasts, as well as the pattern of the closed incisions which somewhat resemble a helium balloon on a string.
"It's a technique that works well for breast lifts and, even better, simplifies the tricky combination of breast augmentation and breast lift. Some doctors don't do augmentations at the same time as lifts because the implants are making the breasts larger at the same time the lift is making them smaller so it's hard to get it just right."
Combining the procedures successfully requires the right aesthetic mix of "give and take." This is complicated by the fact that the procedure can increase the risks of infection, implant exposure and/or malposition, loss of nipple sensation, and nipple or skin necrosis because "of the conflicting goals of augmentation and mastopexy — with augmentation stretching the skin envelope and mastopexy tightening it." Because of this dichotomy, Dr. Pechter says, "The final result may be unpredictable in even the best of hands." Dr. Pechter |
Dr. Pechter explains that with the HB lift, some limitations of the vertical scar procedures can be mitigated by rotating and extending the scar to the lower, outer quadrant of the breast, eliminating the potentially troublesome medial inframammary limb and T-junction of the inverted-T mastopexy.
A LOOK AT TECHNIQUE Pre-operatively, Dr. Pechter marks the patient with a meridian line from each mid-clavicle to each corresponding nipple, with matching 2-cm intervals marked bilaterally.
Intraoperatively, these numbered intervals are useful for maximizing symmetry, especially if intraoperative adjustments of the planned nipple position prove necessary. He uses a wire McKissock keyhole pattern to mark the new areolar window, then places surgical staples to prefigure the desired post-operative appearance of the breast.
He says, "This way, the result can be previewed on the operating table, and since it is not necessary to undermine skin or create a pedicle to carry the nipple/areola, ischemic risks are diminished."
