Key Points
- 'Staple first' technique provides maximum tightening of redundant breast tissue, previsualization of new breast shape and
symmetry
- Surgeon says technique eliminates need for multiple trimmings
- With this technique, some patients experienced dehiscence at juncture of inverted T
A modified version of conventional augmentation/mastopexy surgery enables Philadelphia cosmetic surgeon Ted S. Eisenberg,
D.O., to reduce surgical time and anesthesia while consistently achieving predictable results and high patient satisfaction
in cases of moderate-to-severe ptosis — regardless of implant size used or the amount of skin resected.
Dr. Eisenberg is associate professor of surgery in the division of plastic surgery at the Philadelphia College of Osteopathic
Medicine. He developed a technique that enables him to actually see what the end result of the operation will look like before
making a single incision.
Dr. Eisenberg had been in practice for 19 years before developing this technique, and he had been performing breast surgery
exclusively for five years prior to his innovation. "I had one of those 'Aha' moments, where I thought: Instead of cutting
the tissue away and then tacking it back together and then trimming it, what if I tacked it together first?" Dr. Eisenberg
says.
STAPLE FIRST Dr. Eisenberg says his 'Staple first' technique, which is based on the adage "Measure twice, cut once," provides maximum tightening
of the redundant breast tissue and allows him to previsualize the new breast shape and symmetry before the scalpel is raised
for a one-stage skin resection. "I believe this is a more precise approach than the standard technique of drawing a pattern,
resecting skin and then tailor-tacking the tissues together," he says.
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HOW IT'S DONE First, Dr. Eisenberg performs some initial markings with the patient in the sitting position, but he uses those markings simply
as guide points (as opposed to using them as a pattern). "When the patient is under anesthesia, I use these guide points to
essentially sculpt the breasts by tightening the tissues with surgical staples. Once all of the staples are in place and the
breasts are tight and symmetric, I mark the outline of the staples and then remove the staples. I then follow these markings
and resect precisely the amount of skin that needs to be removed in one shot," he says.
The greatest benefit of this technique, Dr. Eisenberg says, is that it eliminates the need for multiple trimmings. "Instead
of drawing the actual inverted-T pattern, I staple only the apex of the nipple areolar complex and the medial and lateral
points of the inframammary crease, and I use these three points as the starting points of my stapling," he says. "By eliminating
the need for multiple skin trimmings, the procedure is quicker, and it offers an extra level of confidence that the tissues
will come together, that the vascular supply of the tissues won't be compromised, and that the breasts will be symmetric,"
he says.
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Previously, like most surgeons, Dr. Eisenberg relied on complex preoperative skin markings followed by extra skin trimming
in an attempt to achieve symmetric results. After trimming the first breast, he would naturally have to go back to the other
breast to ensure that they were still symmetric. "What's dramatically different with this technique is that when I staple
the redundant tissue first and then take out the staples, I find that the area of skin I can remove is significantly larger
than any amount of tissue that's indicated by drawing a Wise or other pattern," he says.
One disadvantage associated with Dr. Eisenberg's previsualization closure technique is that he has had several patients who
experienced dehiscence at the juncture of the inverted T. However, in patients in whom this has occurred, the largest area
measured approximately 1 cm and spontaneously healed within a couple of weeks with the use of topical Silvadene (silver sulfadiazine,
King Pharmaceuticals).
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