Pectoralis Major Breast Sling | The Breast Surgery Network

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Arrival
When you arrive at the surgery center or hospital, you will be instructed to change into a surgical gown. You may have already been told you could take an oral sedative such as diazepam or lorazepam to ease pre-surgical anxiety, as well as Zofran, or similar, to lessen the nausea often felt after anesthesia. You may see your surgeon at this time and discuss anything which you may have thought of over night, you may also then meet the anesthesiologist who is going to administer your anesthesia during your surgery. Your surgeon may also measure the placement of your areolae in conjunction with your sternal notch, as well as the natural infra-mammary crease and proposed excision areas by making pre-surgical markings with a Sharpie-type pen or similar single use, pre-surgical marker while you are in a standing position.

I.V. Insertion & Monitoring Equipment
After you have changed into your gown you may be lead to the pre-surgical area for IV insertion and medication administration. Once your IV and saline drip is in, your anesthesiologist will be able to infuse medications for nausea or anxiety, and eventually to sedate you and for pain management. You will have a blood pressure cuff placed around your arm, and monitoring adhesive pads placed on your chest and/or arms; these will be hooked up to equipment which will monitor your blood pressure and heart rate. You will also have an oximeter placed on your finger or toe which will be connected to this machine. This device measures the arterial oxygen saturation and will alert the surgical and recovery teams if you are not breathing deeply enough or not getting enough oxygen, in general. If it is removed, or it doesn't have a proper contact, an alarm will sound to alert the team. The oximeter is just as important as your heart rate and blood pressure. If you are not getting proper oxygen saturation, your cells are not receiving the vital oxygen they need to survive. When this happens, it is referred to as hypoxemia. Typical normal oxygen saturation is between 95% to 99%, some patients even 100%.

Anesthesia
When your anesthesiologist infuses a pre-surgical sedative, you may feel very relaxed and sleepy. Many patients go right asleep, others drift in and out of a state of consciousness. This assists in relieving the tension often experienced by patients before they go into the O.R. to begin surgery. You may or may not remember this part of your procedure.

Pre-surgical Scrubbing & Preparation
After you are anesthetized by your chosen method, and your vitals are determined as stable, your urinary catheter is then placed (which is not always necessary so inquire beforehand). You may alps have pneumatic sleeves placed on your lower legs to prevent clot formation in the legs during surgery.

Your surgeon, or the upsetting room staff, will begin to scrub the breasts, upper chest, abdomen and sides of the ribcage with either Betadine (povidone-iodine, 7.5%), pHisoHex (hexachlorophene, 3% ) or Hibiclens (chlorhexidine gluconate, 4%) or similar-type anti-microbial surgical scrub. This will lessen your chances of a bacterial infections from naturally occurring bacteria such as Staphylococcus aureus (S. aureus) which lives on our skin.

The Surgical Procedure
After you are well-scrubbed and draped, your vitals are again determined as stable and your surgeon begins the first incision.

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With the _____________, the incisions are around the areolae (or within the areola borders for an areolae reduction), then in a straight line down from underneath the areola to the natural crease of the breast and within, or directly above, the mammary crease. The areola complex is left on a de-epithelialized pedicle of tissue to preserve circulation and nerve sensation, in this case a superior pedicle (depicted in dark maroon) was used. After these incisions are made the excess skin is removed from the breast. If necessary, the glandular tissue is molded and situated into a higher placement and rejuvenated shape.

After sponge and instrument count, the areolae complex is moved up, and the incision edges are drawn together and sutured, lifting the breast to a new higher position. The sutures will remain in this anchor fashion and around the areolae until about 10 days or more, depending upon the heaviness of the breast and if implants were utilized for augmentation.

After your surgery is over, your catheter is removed if you are not staying overnight and your anesthesiologist will turn off the anesthetic gases and increase the oxygen. You may then have your endo-tube removed unless the anesthesiologist feels a temporary tube is to be left in place to assist in keeping an airway open. An oxygen mask is placed over your nose and mouth and you are told to breath deeply. You may not gain consciousness just yet but will within a few minutes.

You are then transferred to a gurney, covered with a warm blanket, and wheeled into the recovery area. Your vitals are strictly monitored until you are able to breathe well enough on your own without oxygen assistance.

The Immediate Recovery Period: What To Expect

Immediately after surgery, you may feel very disoriented, very confused and possibly emotional because of the anesthetics. If you feel nauseated be sure to let the recovery nurse and anesthesiologist know. Your anesthesiologist or surgeon may administer an anti-nausea medication intravenously. The recovery team will continue to monitor your heartrate, blood pressure and oxygen saturation. After a few minutes, they will begin to say your name to rouse you from your sleep. If you were intubated, you may notice when you try to speak that your throat may be a little sore, this is a normal sensation due to the endo-tube.

You may also feel nauseated. You may feel cold or hot depending upon your own body. If you feel either, do let the recovery nurse know so they can either get you another blanket or remove the heated blanket you may have covering you. if you feel any pain, do let the recovery team know so that you may be given pain medication, however, you usually will not feel pain because of the local anesthetics. If you are nauseated you may have to be given pain medication intravenously, but your anesthesiologist may have you wait until you are more aware and capable of speaking clearly. You will nod off and on during this time and your oximeter may sound if you are not breathing deeply enough, thereby not receiving enough oxygen.

When you are released is usually determined by your oxygen saturation levels and level of awareness. When your anesthesiologist and surgeon have determined if you are well enough to leave, you will be released to your caretaker and driven home. You absolutely can not drive yourself home after a surgical procedure. You will need a caretaker to assist you by waking you for your meds, to fix you something to eat, possibly assist you in walking to the bathroom if you are dizzy from your medications, retrieving items for you such as ice packs, drinking water, etc.

Recovery In The Days Ahead
Please return to the Breast Lift Section for recovery information and what to expect in the following weeks after your Full Anchor Mastopexy surgery.