So we have a variety of areolar templates that we use to give us a perfect circular areolar dimension and incision sight, and what I like to do is make a circumareolar incision to basically embed, engrave that sight. “We’re using’a fifty millimeter diameter.”
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I usually interact with the woman preoperatively to determine how large areola, which is the brown skin around the nipple, she would like to have.
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Then what I do, at this point, is inject the area with local anesthesia that’s long-lasting, in conjunction with a vasoconstricting agent, this gives us an opportunity to then have a patient free of pain upon awakening, and also give us a minimal bleeding during surgery. Then I estimate where those two positions are, and then measure it with are previously mentioned, and it almost always comes out to be exactly where it’s supposed to be. But their shoulder’s back, feet together, head… lift their arms straight up to the sky, straight up to the ceiling, and that gives us an indication, compared to where the nipple position was, with the arms at their sides, to where it’s going to be. The mid-humerus, the mid-upper arm, can correlate to where the new nipple areolar position should be – that’s one method. Once I make those measurements, draw the mid-line, find the midclavicular line, drop the breast meridian, measure where the new nipple’s going to be – and this is an interesting process to determine where will the new nipple be. On the day of surgery we see her in the preoperative holding area, where any last minute questions are addressed, and I usually have the patient stand up with the nurse in attendance, and I go through the markings and exact measurements and drawings that need to be done, in order to guide us during the operative procedure. We reviewed risks and benefits and all the potential complications, and gone through a very extensive educational process for the patient, regarding her particular specific procedure. Prior to surgery we’ve seen the patient at least twice, oftentimes more. So we moved her nipple twelve centimeters or so from where it was, to where it will be. Her distance from her sternal notch to her nipple was well over thirty centimeters, I think it was thirty-three or thirty-four centimeters. We know the distance from the sternal notch, which is where the collar bones join in the middle of the body to the nipple, somewhere between twenty to twenty-two – no more than twenty-three centimeters. When you look at a breast that you believe to look its best. This patient is a young women, under thirty years of age who’s had one pregnancy, but that one pregnancy, because she breast fed, left her with an enormous excess of skin for the volume of her breast.
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