Breast Augmentation Video

This is a live surgery that I've edited down to allow a patient to understand what's involved with the surgery. What you're seeing here is that a woman is asleep on the operating table, and she has marks on her that were made with her standing and that they are being reinforced now with a marking pen. The bright light you are seeing is actually a headlight that I'm wearing on my head and I have a pair of special glasses on that allow me to see. I start on the right hand side and I make an incision under her breasts. This incision is measured and it is three centimeters long. The area that bleeds the most during the surgery is actually just this skin incision, so I'm very deliberate in my making sure that there's not a lot of bleeding. The instrument that you see here is actually used to control the bleeding by heating the tissues and we call it an electrocautery. So I'm cauterizing the edge of the the underside of the skin.

You can see here that the retractor is holding up the skin and the yellow is the fat which is now being separated as well. A pair of scissors have been inserted to separate some of the fat to a deeper layers. A very special retractor is now being inserted. The electric cautery is then used to dissect further into the tissues to expose the underlying chest wall muscle.

The chest wall muscle is now being lifted up with that special retractor and the electrocautery is actually cutting the muscle at the same time it is obtaining hemostasis or stopping all the bleeding so there's actually no bleeding while this muscle is coming up. The light blue tube is actually a suction which is sucking the smoke. The adjustments I'm making with my left hand allow me to continually add pressure to the muscle and allow me to cut it in precisely the area where I want to cut it. This closeup view shows the muscle, and that muscle is coming off of the rib cage. I have a special tip put on the electrocautery which allows me to further release the muscle. If you look closely, you can see the muscle actually jumping from the current of the electricity.

At this point I have completely released the muscle to the area that was required for this particular patient, and I'm going to mark the cut edge of the muscle so I can assure a symmetrical result that I can compare it to the other side.

Now the muscle will be taken and elevated off of the rib cage even higher towards the breastbone or the sternum. All of this is performed under direct vision. At this point, the pocket is being inspected by palpation to assure that the pocket is the appropriate size for the implant. The retractor is replaced and a long acting numbing medication is injected into the muscular pocket.

We have now switched to the other side of the operating table. The scissors and the retractor have been placed and similar to the other side the dissection is continued down to the chest wall. The electrocautery is again used to release the muscle. My fingers inserted to verify that the pocket is the appropriately sized for the size of her implants. The longer electrocautery is inserted to further create the pocket to the appropriate size. Again, this pocket is under her muscle.

The pocket is then reassessed for size and in a moment the two sides will be compared by palpation to assure that the pockets are the same, so that she will have a nice symmetric result. I'm feeling along the cut edge of the muscle to make sure that the release of the muscle is symmetric. If there are any bands or areas that I have concern about, I will mark them with the marking pen.

The retractor is again inserted into the pocket and once again under direct vision, the pocket is inspected for any areas of bleeding which would be controlled using the electrocautery. Having assured that the pocket is the correct size and there is no bleeding, the implant has been folded in a specific manner and is inserted into the submuscular pocket or the pocket below the muscle. The insertion tube is confirmed to be in the correct position. The implant is now being adjusted so that it lays down in the correct fashion, and now the breast implant will be filled with saline.