Hi I'm Dr. Megan Gruber at Gruber Plastic Surgery in Tampa Florida and today we're going to be showing you an awake breast reduction. I'll show you just a little bit of technique how to numb the breast with tumescent fluid. How are you doing? Wave to the camera. Okay so it's great to put the fluid underneath the breast. You don't want to try to put it through the breast tissue so we put it underneath the breast on. That feel okay? Yes ma'am. Do you feel pressure? Yes. Do you feel sharp pain? No sharp pain. Okay and you can see I'm going all the way under the breast across over the pec muscle fascia and underneath the breast tissue. Forward. So you can see this is the part that people don't like in front of the breast here so we're going to numb that area. You can see we're coming around the breast. Patient can help by turning their body and we're going to come down and do this bottom quadrant. You doing okay? Yes doctor. I'm using my awake surgery tumescent fluid. This solution is my own mixture of 1,500 milligrams of lidocaine, 150 milligrams of opivocaine, and 1.5 milligrams of epinephrine. Okay so first I numb the underneath of the breast then I numb on top of the breast and now when I numb a little bit through the breast. Wave for everybody. Hi everybody. You're doing great. The lipo of the breast continuing down. We want to get mostly the lateral lumen here just like a breast reduction except for removing the stuff with lipo. Okay so we've done the reduction lipo on the right side and the left side hasn't been done yet and I thought I'd just show you the volume difference that we were able to get. So the volume on this side is about like a 400 cc C cup big C small D and volume on this side is her original breast with some fluid in it not a lot. With patient on their side with their shoulder extended like this and retracted back is a nice way to open up the tail of the breast and the lateral axillary area. Are you doing okay? Yes ma'am. Give us a wave and a thumbs up and remember we're going to lift the IMF up like an inch and a half you know so like five centimeters or so. So I need to get everything out of this bottom inframammary fold. Anytime you feel a little bit more discomfort in one area or another I use 10 cc's of quarter percent lipocaine, quarter percent ropivacaine. So it's a very low dose but it's just concentrated to that one area. Alright so we did the lipo. Her bra rolls, her axilla, and her breasts are lipo'd to the size that she wants her breasts to be. That is how we like it and you do too. Okay. Okay so we have completed the skin removal and as you can see it's basically like a regular breast reduction or breast lift. That's basically it. So we're just gonna irrigate with some antibiotic solution and tailor-packaged shut. So the second breast has been reduced with lipo and she's still awake. Hey! Now we're just detaching the inferior part of the pedicle. So this portion here has been liposuctioned. You can see there's no breast tissue or fat on the inframammary fold. So this is the old inframammary fold and the new one's going to be up here but an inch and a half or so. All right so we're going to just close this up and I'll show you a little bit more.

awake breast reduction

tumescent fluid

liposuction

Megan Gruber

inframammary fold