My Personal Techniques

Dr. DeConti has over two decades of experience in the placement of thousands of breast implants. He has additional experience and training in the placement of implants through a trans-axillary (armpit) incision with the use of the Endoscopic Camera System. He also uses a ‘No Touch’ and ‘Minimal Tissue Trauma’ technique to help minimize infection, postoperative pain and bruising. Dr. DeConti has extensive experience in the placement of larger volume implants as well as the correction of complications associated with breast augmentation procedures.

Breast Augmentation takes about forty minutes and the patient is under general anesthesia for optimum management and comfort. The procedure is performed in an accredited, private surgery center with an anesthesiologist.

After the patient is asleep, she is prepped and draped. The incisions are then marked. The breasts and incisions are then infiltrated with a Xylocaine and Marcan mixture to help with postoperative pain control. Epinephrine is also used to help maximize the effect of the Xylocaine and Marcan and minimize postoperative bruising.

Dr DeConti uses three types of incisions, inframammary, trans-axillary, and periareola, for breast augmentation depending on the patient’s preference. If an inframammary incision is chosen, it is usually less than one inch in length. If saline implants are used they can be rolled up like a ‘cigar’ smaller than their actual size, placed in the breast pocket, then unrolled and inflated with saline. The incision will be larger with gel implants because they cannot be made smaller.

If a patient chooses a trans-axillary incision, Dr. DeConti uses the Endoscopic Camera System. Traditionally surgeons have dissected the pocket bluntly and blindly with a long instrument because of the distance from the armpit to the implant pocket under the nipple. This can lead to an increased risk of complications including bleeding, malposition, and bottoming out. The endoscopic camera system allows the implant pocket to be dissected under direct vision which minimizes bleeding and tissue damage, and over dissection of the pocket, thus effectively decreasing postoperative complications. It also allows visualization of placement of the implant for accuracy.

The periareola incision is mainly used when the patient requires a breast lift. This incision is more visible than the inframammary or trans-axillary incision.

Once the incisions are made, the pocket is created. The majority of implants are placed under the pectoralis muscle. This helps to give them greater tissue coverage so they appear more natural, may decrease the risk of rippling by producing a constant mild compression on the implant, and make reading mammograms easier due to the additional tissue plane between the implant and the breast.

After the pocket is dissected, the inner inferior portion of the pectoralis muscle is released. This prevents the contraction of the pectoralis muscle from pushing on the implant and moving it down and towards the side of the chest. This is especially important in trans-axillary augmentation, which has a greater risk for this displacement. It should be noted that only a small portion of muscle is released and it does not interfere or change one’s strength, shape, or function or cause malposition or bottoming out.

The pocket is then irrigated with saline and visualized for bleeding which is controlled. Triple antibiotic solution is then used to irrigate the pocket to help prevent infection.

Dr. DeConti uses round, smooth, textured , teardrop, anatomical implants, saline and gel implants. He also uses both Allergan (Inamed-Mcghan) and Mentor products. The implant style is chosen by the patient in the preoperative visit based on the patient’s personal desires.

The implant is opened and utilizing the ‘No Touch’ technique is rolled and inserted in the less than one inch incision into the subpectoral pocket. The implant is not allowed to touch anything including the patient’s skin to help minimize any risk of infection. If a teardrop, anatomical implant is used, it is marked for orientation before inserting. After being inserted, it is inflated with saline to the manufactures recommended fill volume using a closed technique.

The tissues are then released to allow redraping of the skin over the implant. After the opposite side is completed in a similar manner, the patient is then visualized in both a sitting and lying down position to check for proper placement and orientation.

The incisions are then closed with a deep layer of absorbable sutures. A second layer of absorbable suture is used to close the deep dermis, and a final third layer of absorbable suture is used to close the dermis just under the skin. There are no exposed sutures to be seen or to be removed. Small butterfly tape dressings are placed over the incision.

The patient is visualized one last time in the sitting and lying down position to make sure the implants are symmetric and in proper position. A gauze dressing is then placed over the incisions.

The patient is then gently awakened from the anesthesia and taken to the recovery room. The post recovery period is about one hour.

CareCredit Richmond Virginia DeConti Plastic Surgery
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