Operative procedure
All cases were operated under general anaesthesia with endotracheal intubation. After anaesthesia, tumescent infiltration was done. The infiltration was about 1:1 with the expected aspiration volume, and covered the marked area of the chest with additional area for feathering from the clavicle to below the inframammary fold.
After infiltration is complete, de-epithelisation of the marked area (between 1st and 3rd markings) was done in circular manner [Figure 4b] and liposuction is started with a 3 mm Mercedes Benz cannula through a small stab incision made along the outer lateral margin of the de-epithelised area.
After the liposuction was completed, the lateral margin of stab incision for liposuction was extended 2-2.5 cm further. Through this window, the redundant portion of the breast tissue was removed by sharp dissection keeping 1.5-2 cm breast tissue under the nipple-areola complex.
The margin of the areola was then fixed at mid-humerus lavel just medial to the mid-clavicular line with pectoralis fascia at 10, 2, and 6 o'clock position with 3-0 monocryl. Outer border of the de-epithelised area was sutured by subdermal 3-0 monocryl suture, which gave a purse-string effect and made close contact of the two incision lines. These two lines were further apposed by few half buried horizontal mattress sutures [Figure 4c].
A suction or a small corrugated rubber drain were inserted through a separate stab incision over anterior axillary line and usually removed after 24 hr. Compressive dressing were used for 6 weeks.