Endoscopic Mastopexy and Breast Reduction

Abstract

New concepts regarding skin elasticity were introduced in the fi eld of plastic surgery by way of innovative techniques of liposuction and circum-mammary breast reduction [1–3]. Th ese new concepts, which concern the capacity of the skin to retract, allowed the author to investigate the feasibility of applying endoscopic methods to subcutaneous tissue to avoid skin resection. Th e author began by modifying the miniabdominoplasty technique as well as the techniques for breast reduction and mastopexy – endoscopy was also used as an aid for the fl ap harvesting and placement of tissue expanders – and developed promising research regarding axillary and inguinal lymph node dissections [4]. Video endoscopic methods have been used in diff erent surgical fi elds such as gynecology, orthopedics, and general surgery where many advantages have been shown. Th ere are less tissue trauma, lower rates of infection, and minimal scars [5]. Laparoscopic procedures use pressurized CO2 gas to create a space between the laparoscope and the tissue to allow visualization. In the subcutaneous tissue, however, pressured gases are not recommended because of the risk of embolism. To circumvent this risk, the author developed the “subcutaneous tomoscope” which is an instrument that transfers into a transparent capsule the needed space for illumination and visualization. Th e optical cavity functions much the same way as a scuba diving mask does while serving as a blunt dissector because of its wedge-shaped capsule [4]. Specially designed retractors were developed to increase the necessary working space as well as other instruments such as special needle holders and needles (Fig. 42.1). All of these instruments were designed to work through minimal incisions. With video endoscopy, delicate processes can be performed through minimal incisions that can be made at strategically placed and remote sites avoiding visible scars. Th is is an important goal in the fi eld of aesthetic surgery where scars are undesirable and may sometimes compromise the fi nal aesthetic result. 42.2 Endoscopy for Mastopexy and Breast Reduction