Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Polymastia surgery can be performed under local anesthesia with sedation or general anesthesia, depending on the volume of tissue and patient preference. For significant excision, general anesthesia is often preferred to ensure complete muscle relaxation and patient comfort. A board-certified anesthesiologist monitors vital signs throughout the procedure.
Safety protocols include precise positioning of the arm to allow access to the axilla without overstretching the brachial plexus. The surgical field is prepped with sterile solutions, and antibiotics are administered prophylactically to prevent infection in the sweat-gland-rich axillary environment.
The surgery begins with the infiltration of a tumescent solution—a mixture of saline, lidocaine, and epinephrine. This fluid serves multiple purposes: it numbs the area, constricts blood vessels to minimize bleeding, and physically separates the target tissue from the surrounding structures (hydro-dissection).
This step is critical for safety. By expanding the tissue planes, the surgeon can more easily distinguish the accessory breast tissue from the delicate nerves and lymphatics that lie deeper in the armpit. It creates a more transparent, safer surgical roadmap.
In most cases, the procedure starts with liposuction. Even if the mass is glandular mainly, there is always a fatty component. The surgeon uses a cannula to aspirate the surrounding fat. This “debulking” process defines the borders of the glandular tissue and loosens it from the skin.
Advanced techniques such as VASER (ultrasound-assisted) or power-assisted liposuction may be used to break down fibrous septa. This step sculpts the peripheral areas of the axilla, ensuring a smooth transition between the surgical site and the chest wall, preventing a “scooped out” deformity.
Following liposuction, the dense glandular core usually remains. This tissue is too tough to be removed by suction alone. The surgeon makes a discrete incision in the axillary apex and performs a direct excision. Using precise dissection, the gland is separated from the skin above and the fascia below.
This is the curative part of the surgery. The surgeon ensures that the entire glandular mass is removed to prevent recurrence. Care is taken to remove any tissue extensions that might run toward the breast or down the arm.
Once the volume is removed, the surgeon assesses the skin envelope. If there is significant redundancy, the excess skin must be excised to prevent sagging. The skin is pulled upward into the axilla, and a crescent-shaped segment is removed.
The edges are then brought together. This redraping process tightens the skin of the lateral chest wall and armpit. The surgeon meticulously tailors the skin excision to ensure the final scar lies flat and falls within a natural skin crease, avoiding tension that could widen the scar.
The axilla contains sensory nerves, specifically the intercostobrachial nerve, which provides sensation to the inner arm. During dissection, the surgeon employs blunt techniques to identify and preserve these nerves whenever possible.
While some temporary numbness is common due to the interruption of tiny skin nerves, protecting the major sensory branches is a priority. This careful navigation minimizes the risk of permanent numbness or painful neuromas in the inner arm area.
The axilla is a highly mobile area prone to fluid accumulation (seroma). Achieving absolute hemostasis (stopping bleeding) is vital. The surgeon uses electrocautery to seal small vessels. In cases of large excisions, a small suction drain may be placed.
The drain helps remove fluid and blood that accumulates in the “dead space” left by the removed tissue. This allows the skin to adhere firmly to the underlying muscle, speeding up healing and reducing the risk of seroma.
The incision is closed in layers. Deep absorbable sutures are used to close the subcutaneous tissue and reduce tension on the skin edges. The skin itself is typically closed with a running subcuticular (under the skin) suture that does not require removal.
This layered approach ensures a strong repair and a fine-line scar. Surgical glue or sterile strips are applied over the incision to seal it from bacteria and provide additional support during the initial healing phase.
Immediately after surgery, a compression dressing is applied. This typically involves bulky pads placed in the armpit, held in place by a compression vest or specialized bandage. This pressure is crucial for preventing swelling and bleeding.
The compression acts as a mold, keeping the skin flat against the chest wall. It restricts the movement of the area, providing comfort and stability during transport to the recovery room.
In the recovery room, the patient is monitored for pain and circulation. The arm is kept slightly abducted (away from the body) to prevent pressure on the incision. Nursing staff check for signs of expanding hematoma, which would present as rapid swelling or severe pain.
Pain is generally managed with oral medication. Once the patient is alert, stable, and able to drink fluids, they are discharged with detailed instructions for home care.
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The procedure typically takes between 1 and 2 hours, depending on whether it is one side or both, and how much tissue needs to be removed.
In many cases involving significant tissue removal, yes. You may have a small bulb drain for 2 to 5 days to collect fluid. This prevents fluid pockets from forming and helps you heal faster. If the removal is small, drains might not be needed.
Most patients describe the recovery as “sore” rather than acutely painful. It feels like a strained muscle in the armpit. You will have restricted arm movement for a few days, but oral pain medication usually manages the discomfort well.
The scar is hidden high up in the deepest fold of the armpit. When your arm is down, it is entirely invisible. Even when your arm is raised, the scar blends into the natural skin creases.
No. You will likely have had sedation or general anesthesia, and your arm movement will be restricted. You must have a responsible adult drive you home and stay with you for the first 24 hours
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