US20080086169A1 - Minimally-invasive mastoplasty procedure and apparatus - Google Patents

Abstract

Medical devices and methods are provided for a minimally-invasive mastoplasty procedure. In the procedure, barbed sutures are used to accomplish the mastoplasty through puncture wounds by deploying the sutures caudally from stable anatomical features into the breast tissue.

Description

CLAIM OF PRIORITY
• This application claims priority to U.S. Provisional Application No. 60/833,999 entitled “Minimally-Invasive Mastoplasty Procedure” filed Jul. 28, 2006 and [Attorney Docket No. ANGIO-01006US0] which is hereby incorporated by reference.
BACKGROUND OF INVENTION
• This invention relates to minimally-invasive methods and medical devices for performing cosmetic breast surgery or mastoplasty. More, specifically, the invention provides methods and devices for performing breast and nipple-lifts and contouring the surface of the breast without the need for open surgery.
• A breast-lift (mastopexy) is usually performed for drooping breasts (mastoptosis), which may occur with age, after weight-loss or after a woman has had children. The skin loses its elasticity and the breasts lose their firmness and shape as they sag under the effects of gravity. The degree of droop or ptosis is measured by how far the nipple has fallen below the inframammary fold. Mastoptosis requiring mastopexy is present when the nipple has fallen below the plane of the projected inframammary fold. However, cosmetic breast surgery or mastoplasty may be performed for aesthetic reasons regardless of the extent of ptosis present.
• Surgical mastopexy is the standard treatment for mastoptosis. In 2004 more than 98,000 mastopexy procedures were performed in the United States. Breast-revision surgery such as mastopexy is an invasive open surgery procedure. The procedure is performed under general anesthesia, either in an outpatient facility or in the hospital. Most patients require a two-day hospital stay. During the procedure, incisions are made along the natural creases in the breast and around the dark pink skin surrounding the nipple (areolus). A keyhole-shaped incision above the areolus is made to define the new location of the nipple. Skin is then removed from the lower section of the breast. The areolus, nipple (nipple-areola complex or NAC), and underlying breast tissue are moved up to a higher position. The breasts are lifted using suspension sutures in the deep parenchymal tissue and tucks in the redundant skin. The NAC is moved up into the keyhole incision and all the incisions are closed with sutures. Large incisions are required, and in order to elevate the NAC, periareola incisions are always required. The sutures remain for two weeks after surgery and are then removed. It is a disadvantage of the mastopexy procedure that it requires long incisions, and, although care is taken to reduce scarring, some scarring is usually evident. A further disadvantage is that the long incisions and exposed tissues create a risk of post-operative infection.
• After surgery, a bulky gauze dressing is wrapped around the breasts and chest. Sometimes a surgical bra is used. The patient is usually in significant pain, which necessitates control by medication for the first few days. Generally, the swelling and discoloration around the incisions take a few days to subside. The surgical dressing must be worn for up to a week at which point it is replaced with a surgical bra, which must be worn for several weeks.
• Thus, the open mastopexy procedure requires a lengthy hospital stay and an even longer convalescence period in which the patient may not be able to work. Patients may not return to even low impact exercise until three weeks following surgery and to higher impact activities such as jogging, until six weeks following surgery. The patient may suffer discomfort in this period after the procedure, requiring further medication. Possible side effect of the procedure, include scarring and temporary loss of sensation in the breast skin and nipples.
• It would therefore be desirable to provide a breast-lift and/or NAC-lift procedure, which does not require long incisions and can be performed with a minimally-invasive procedure.
• It would also be desirable to provide a breast-lift and/or NAC-lift procedure, which reduces the pain, and discomfort suffered by the patient and reduces the recovery time of the patient.
• It would further be desirable to provide a breast-lift and/or NAC-lift procedure, which reduces the risk of scarring and scar tissue formation.
• It would still further be desirable to provide a breast-lift and/or NAC-lift procedure with reduced incidence of side effects such as temporary loss of sensation and infection.
BRIEF DESCRIPTION OF THE DRAWINGS
• Features of the invention, its nature and various advantages will be apparent from the accompanying drawings and the following detailed description of various embodiments, in which:
• FIG. 1 shows a suture for performing procedures of an embodiment of the present invention;
• FIGS. 2A-2C show detail views of the suture ofFIG. 1;
• FIG. 3 shows anatomical features and markings that may be made during planning for a breast-lift and/or NAC-lift procedure;
• FIGS.4A-D show the steps of a method for a breast-lift and/or NAC-lift procedure according to one embodiment of the present invention;
• FIG. 5A-L show alternative deployments for breast-lift and/or NAC-lift procedures in accordance with different embodiments of the present invention;
• FIGS.6A-D show the steps of a method for a NAC-lift procedure according to one embodiment of the invention; and
• FIGS.7A-D show the steps for a combination breast-lift and NAC-lift procedure according to one embodiment of the present invention.
DETAILED DESCRIPTION
• In view of the foregoing background of the invention, it is an object of the present invention to provide a breast-lift procedure which does not require long incisions and can be performed with a minimally-invasive procedure.
• It is also an object of the present invention to provide a breast-lift and NAC-lift procedure, which reduces the pain, and discomfort suffered by the patient and reduces the recovery time of the patient.
• It is a further object of the present invention to provide a breast-lift and NAC-lift procedure, which reduces the risk of scarring and scar tissue formation.
• It is a still further object of the present invention to provide a breast-lift and NAC-lift procedure with reduced incidence of side effects such as temporary loss of sensation and infection.
• These and other objects of time present invention are accomplished as described in the drawings and detailed description of the invention by providing a minimally-invasive breast-lift and/or NAC-lift procedure that utilizes one or more lengths of barbed suture material introduced through tiny punctures to lift and contour the breast and/or lift the NAC. The invention provides a range of procedures for deploying the bidirectional sutures depending upon the lifting and contouring effects desired to be achieved and the patient's anatomy.
• In a general embodiment, one or more lengths of bidirectionally-barbed suture are introduced through puncture wounds above the breast and fixated to a stable anatomical feature such as the fascia pectoralis. Long needles are utilized to deploy both ends of the suture caudally from the insertion point through breast tissue to exit lower on the breast. The deployment lines and deployment depth are controlled to achieve the desired effects. When the sutures are in place, the breast tissues are manually advanced along the sutures until the desired elevation and contouring is achieved. The barbs on the sutures are oriented to optimally support the tissue against gravity along the length of the sutures and maintain the desired contouring and elevation. In this manner, the effects of surgical mastopexy can be achieved without long incisions and the associated disadvantages of pain, scarring, and possible loss of sensation.
• Other objects, advantages, and embodiments of the invention are set forth in part in the drawings, the description which follows, and in part, will be obvious from the drawings and the description, or may be learned from the practice of the invention.
• Barbed Sutures
• Referring now to the drawings, wherein like reference numerals designate corresponding or similar elements throughout the several views, there is shown inFIGS. 1, 2A,2B and2C a bidirectional barbed suture for use according to the present invention and generally designated at100.Suture100 includes anelongated body102 having a plurality ofbarbs104 disposed along the length of thebody102. First and second ends106,108 ofbody102 are affixed toneedles110,112 for penetrating tissue.Needles110,112 each have: aproximal end114,116 for receivingsuture100; anelongate shaft118,120; and a sharpdistal tip122,124 for penetrating tissue in a controllable and steerable manner.Needles110,112 are shown as straight needles but they may be curved as necessitated by the demands of the procedure.
• Body102 ofsuture100 is, in one embodiment, circular in cross section. Suitable diameters forbody102 ofsuture100 may range from about 0.001 mm to about 1.0 mm. In general,body102 ofsuture100 should be sized such that it has sufficient tensile strength to serve in its intended application but does not cause unnecessary least disruption to the tissues through which it passes.Body102 ofsuture100 could also have a non-circular cross-sectional shape, which would increase the surface area ofbody102 and facilitate the formation ofmultiple barbs104.
• The plurality ofbarbs104 is axially spaced alongbody102 ofsuture100.Barbs104 are oriented in one direction facing toward thefirst end106 of thesuture100 for afirst portion128 of the length of the suture and in an opposite direction facing thesecond end108 of thesuture100 for asecond portion126 of the suture.Optionally suture100 may also be unbarbed in athird portion129 located betweenbarbed section128 andneedle110, andfourth portion127 located betweenbarbed section126 andneedle112. These additional portions of the suture need not be barbed as they will not remain in the patient after deployment but they are useful during deployment. These portions can be left unbarbed to make them stronger and easier to handle during the procedure.
• Barbs104 are yieldable towardbody102 as shown byarrow202 ofFIG. 2A.Barbs104 on eachportion126,128 ofsuture100 are oriented to allow movement ofsuture100 through the tissue in one direction along with thecorresponding end106,108 ofsuture100.Arrow204 ofFIG. 2A indicates the direction in whichbody102 may move through tissue.Barbs104 are generally rigid in an opposite direction to preventsuture100 from moving in the tissue in the opposite direction.Section130 betweensections126,128 is unbarbed to increase its tensile strength. Suture100 could be formed in one piece or could be formed from two sutures each with barbs oriented in one direction. Twosutures100 could be tied or joined together at their ends.
• Barbs104 can be arranged in any suitable pattern, for example, in a helical pattern. The number, configuration, spacing and surface area ofbarbs104 can vary depending upon the tissue in which suture100 is used, and depending on the composition and geometry of the suture body. The proportions ofbarbs104 may remain relatively constant while the overall length ofbarbs104 and the spacing ofbarbs104 are determined by the tissue being connected. Ifsuture100 is intended for use in fatty parenchymal tissue, which is relatively soft,barbs104 can be made longer and spaced farther apart to increase the holding ability in the soft tissue. Moreover, the ratio of the number ofbarbs104 on thefirst portion126 of thesuture100 to the number ofbarbs104 on thesecond portion128, and the lengths of eachportion126,128,130 can vary depending on the application and needs. The length ofsuture100 andsections126,127,128,129,130 can vary depending on several factors such as variations in patient anatomy and the particular deployment pattern selected. Asuture100 of proper length is selected for achieving suitable results in a particular application.
• The surface area of thebarbs104 can also vary. For example, fuller-tippedbarbs104 can be made of varying sizes designed for specific surgical applications. For joining fat and relatively soft tissues,larger barbs104 are desired, whereassmaller barbs104 are more suited for collagen-dense tissues. There are also situations where a combination of large andsmall barbs104 within the same structure will be beneficial such as when asuture100 is used in tissue repair with differing layer structures. Use of the combination of large andsmall barbs104 with thesame suture100 whereinbarb104 sizes are customized for each tissue layer will ensure maximum anchoring properties.
• One method of creating barbed suture is to take a standard suture thread and cut barbs with a desired geometry. As shown inFIG. 2A,barbs104 can be specified by a number of characteristics.Cut angle209 defines the angle at which a blade enters the suture to cut the barb.Barb length206 defines the length of the cut made into the suture at the cutting angle. Barb spacing207 is the axial distance between adjacent barbs.Cut depth208 is the maximum depth of the cut into the suture measured radially. Thecut depth208 is dependent upon thecut angle209 and cutlength206. The cut depth needs to be chosen based on thediameter205 ofsuture100 such thatsuture100 has enough tensile strength to perform the tasks for which it is intended. The barbs can be arranged in any suitable pattern on the suture. The barbs are shown inFIG. 2A on opposite sides ofbody102 for ease of explanation. However, as shown inFIG. 2B, a cross-sectional view along the axis ofbody102, the geometry of the barbs can be defined by the angle X betweenadjacent barbs104. If the barbs are cut by a single blade, the suture material may be rotated between cuts, in which case, angle X is controlled by the number of times suturebody102 is rotated per unit distance.
• Material for thebody102 of thesuture100 is available in a wide variety of monofilament suture material. The particular suture material chosen depends on the strength and flexibility requirements. In one embodiment, the material forbody102 is flexible and substantially nonresilient so that the shape of an insertedsuture100 will be determined by the line of insertion and the surrounding tissue. In some applications, however, it may be desirable for at least a portion of thebody102 to have sufficient dimensional stability to assume a substantially rigid configuration during use and sufficient resiliency to return to a predetermined position after deflection therefrom. Variations in surface texture of thebody102 of thesuture100 can impart different interaction characteristics with tissues.
• Body102 ofsuture100 may be formed from non-absorbable material such as nylon, polyethylene terephthalate (polyester), polypropylene, and expanded polytetrafluoroethylene (ePTFE). Alternatively,suture body102 can also be formed of metal (e.g. steel), metal alloys, plastic, or the like. It is also desirable that the material be of high tensile strength and low visibility. In one embodiment, the suture is formed from transparent polyester so as to reduce its visibility after implantation.
• The needles may be constructed of stainless steel or other surgical grade metal alloy. The length of the needles is selected to serve the type of tissue being repaired so that the needles can be completely removed leaving thesuture body102 in the desired position within the tissue. In one embodiment of the present invention, the needles are 11-inch long straight needles with a taper tip having a cutting edge only on one side. An advantage of this type of tip is that it pushes away tissue at the tip rather than severing it as the needle passes. This reduces disruption to the tissues as the suture is deployed and reduces bruising and recovery time.
• The needles may be secured to thesuture body102 by means of adhesives, crimping, swaging or the like, or the joint may be formed by heat shrinkable tubing. Alternatively thesuture100 may pass through an eye provided in the needle. A controlled-release connection may also be employed such that the needles may be removed from thebody102 of thesuture100 by a sharp tug or pull.
• In one embodiment of a bidirectional suture for use in a breast-lift procedure such as shown inFIGS. 4A-4D,5A-5L,7A,B,D, the suture material is a clear, non-absorbable, sterile surgical strand of polypropylene of USP Size 2. Polypropylene is a suitable material for this application because polypropylene threads elicit a minimal acute inflammatory reaction in tissue. Implantation of polypropylene threads is followed by gradual encapsulation, however, polypropylene is not absorbed, and no known change in tensile strength in vivo has been identified.
• In one embodiment for use in a breast-lift procedure,suture100 is 111 cm long,barbed sections126,128 are each 19 cm long,unbarbed section130 is 5 cm long andunbarbed sections127,129 are each 34 cm long. In another embodiment,suture100 is 129 cm long,barbed sections126,128 are each 21.9 cm long,unbarbed section130 is 5 cm long andunbarbed sections127,129 are each 40 cm long. The dimensions of thebarbed section126,128 ofsuture100 allow the suture to be deployed and support tissues along the entire length of the deployment paths required to perform the procedure. The additionalunbarbed lengths127,129 ofsuture100 allow insertion and withdrawal of the 11 inch needles during suture deployment but are not required to be barbed as they will not remain implanted in the patient.
• In one embodiment for use in a breast-lift procedure,barbs104 are cut into a standard USP size 2 polypropylene suture material with a circular cross-section. The barbs onbarbed sections126,128 are defined as follows: cutangle209 is 12 degrees;cut length206 is 0.0320 inches;cut depth208 is 0.0068″±0.0034 inches; and thedistance207 between barbs is 0.373 inches. The suture is rotated 2.21 times per inch of suture and there are approximately 27 barbs per inch, thus angle X between adjacent barbs is approximately 30 degrees. In one embodiment the minimum tensile strength of the suture after creation ofbarbs104 is 8.0 lbs.
• In one embodiment for use in a breast-lift procedure, theends106,108 ofsuture100 are swaged to the proximal ends114,116 ofsurgical needles110,112. For this embodiment, the needles are specified as: 470S/S, 0.039 inch diameter, 11 inches long with a taper cutting point.Needles110,112 are secured at each end of thebody102 of thesuture100 so thatbody102 extends between the shank ends of the two needles (proximal ends114,116). As shown inFIG. 2C,needle110 has anaxial hole210 atend114 in which end106 ofsuture100 is swaged according to standard practice.
• In one embodiment of a suture for an NAC-lift procedure in accordance withFIGS. 6A-6D,7C,D the suture material is clear, non-absorbable, sterile surgical strand of polypropylene of USP Size 1-0. In one embodiment,suture100 is 129 cm long,barbed sections126,128 are each 21.9 cm long,unbarbed section130 is 5 cm long andunbarbed sections127,129 are each 40 cm long. The dimensions of thebarbed section126,128 ofsuture100 allow the suture to be deployed and support tissues along the entire length of the deployment paths required to perform the procedure. The additionalunbarbed lengths127,129 ofsuture100 allow insertion and withdrawal of the 11 inch needles during suture deployment but are not required to be barbed as they will not remain implanted in the patient.
• In one embodiment of a suture for an NAC-lift procedure barbs104 are cut into a standard USP size 1-0 polypropylene suture material with a circular cross-section. The barbs onbarbed sections126,128 are cut into defined as follows: cutangle209 is 12 degrees;cut length206 is 0.0216 inches;cut depth208 is 0.0046″±0.0023 inches; and thedistance207 between barbs is 0.373 inches. The suture is rotated 2.21 times per inch of suture and there are approximately 27 barbs per inch, thus angle X between adjacent barbs is approximately 30 degrees. In one embodiment the minimum tensile strength of the suture after creation ofbarbs104 is 4.5 lbs.
• In one embodiment of a suture for an NAC-lift procedure, theends106,108 ofsuture100 are swaged to the proximal ends114,116 ofsurgical needles110,112. For this embodiment, the needles are specified as: 470S/S, 0.039 inch diameter, 11 inches long with a taper cutting point.Needles110,112 are secured at each end of thebody102 of thesuture100 so thatbody102 extends between the shank ends of the two needles (proximal ends114,116). As shown inFIG. 2C,needle110 has anaxial hole210 atend114 in which end106 ofsuture100 is swaged according to standard practice.
• Surgical Procedures
• The present invention provides a surgical procedure that uses one or morebarbed sutures100 to perform a minimally-invasive breast-lift or NAC-lift. In general, the procedure comprises the following steps: placement, fixation, deployment and elevation. Additionally, after the elevation step, any puncture wounds or incisions can be closed in standard surgical fashion. In the placement step, the physician locates and marks on the skin of the patient the insertion and exit points for the sutures, and the deployment lines along which the sutures will travel. The deployment lines are selected so that the suture, when deployed, engages the area of tissue required to be repositioned to achieve the desired effects. In the fixation step, the surgeon fixes the suture to a stable anatomical feature such as the fascia pectoralis to prevent movement or migration of an anchored portion of the suture and creates a fixation point or anchor. In the deployment step, the physician inserts the suture in a generally caudal or caudal and lateral direction along deployment lines between the insertion points and the exit points at a deployment depth selected based upon the type of tissues required to be engaged to achieve the desired effect. In the elevation step the physician applies tension to the free ends of the suture and manually groups and advances the tissues along the suture to achieve the desired elevation and contouring of the breast tissue. The barbs on the suture are oriented in such a way that the barbs along the length of the suture support the tissues in the elevated position. In the closing step, the physician removes the needles used during deployment, cuts off the excess suture material and closes the insertion and exit wounds.
• After surgery, the patient is provided with appropriate post-operative care in accordance with standard post-operative practice. Subjects may be provided with breast support during recovery from the procedure. Breast support may include tape applied to the breast. For example, two pieces of two inch tape may be applied to the chest horizontally, medially and laterally with the tape touching at each corner of the lower pole of the breast. This creates a supportive “U” shape around/on the breast. Additionally, breast support may be provided in the form of a support bra.
• As described above, in the fixation step, the surgeon fixes the suture to a stable anatomical feature to prevent movement of an anchored portion of the suture and creates a fixation point. One way to anchor the suture and create a fixation point is to loop the suture through the fascia pectoralis. The fascia pectoralis is a thin inelastic lamina of connective tissue, covering the surface of the muscles of the chest (pectoralis major). The fascia pectoralis is attached, in the middle line, to the front of the sternum; and above, to the clavicle. The fascia pectoralis is a stable anatomical feature that provides a strong and immobile anchor for the suture and thus prevents migration of the suture. The stability of the fascia pectoralis as an anchor is enhanced in regions proximate to the sternum and clavicle where the fascia pectoralis is connected to a bone.
• FIG. 3. illustrates preparation the physician may make prior to placement of the sutures. During preparation for the procedure, the physician identifies particular anatomical features on the patient and marks navigational lines in ink on the patient to aid with the procedure. For example, the physician may identify, and mark if needed, the following anatomical reference points:sternal notch302,clavicle304, outline ofsecond rib306,nipple308,areolus310,midline312, transethial line through the center of thenipple314,natural breast vector317 from the nipple through the sternal notch,inframammary fold316,vertical line315 andlowest contour line318.Vertical line315 is shown passing from the nipple to aposition 6 cm along the inferior border of the clavicle.Lowest contour line318 is marked on the most pendent edge of the breast with the patient in an upright position.Navigation lines314,315,317, and318 are useful guides for determining the location of insertion and exit points and the appropriate trajectories for deployment of the sutures. The navigational lines are shown as dotted lines inFIG. 3 in order to avoid confusion with the anatomical features of the chest, however, a surgeon usually marks solid lines in ink on the patient during preparation for the procedure. Also shown inFIG. 3 are the relative directions: cranial320 meaning towards the head; caudal322 meaning toward the posterior; medial324 meaning close to the midline; and lateral326 meaning away from the midline. Other descriptors of direction may be used in this application as may be inferred from the context, for example, above, and higher may refer to a more cranial location, while below, lower and lowest may refer to a more caudal direction.
• After identifying the anatomical markers of the patient, the physician may prepare for placement of the suture. As shown in the example breast-lift procedure ofFIG. 4A, the physician marks insertion points402, insertion-exit point404, and exit points406,408 on the patient's skin using a marker. In one embodiment, points402 and404 are marked over the second rib one centimeter either side ofnatural breast vector317 from the sternal notch to the nipple. As will be illustrated later, insertion-exit point404 serves both as an exit point and an insertion point. In addition to the insertion and exit points, the physician also marks the intended trajectory of the suture on the patient's skin as indicated by dashedlines410,412,414. Placement depends on the anatomy of the patient and the aesthetic effects desired by the patient. In general, for a breast-lift, the insertion points are above or cranial to the exit points on the breast. Depending on the anatomy, the insertion points may also be placed medial of the exit points as shown ifFIG. 4A. In addition, the insertion points are located so as to allow anchoring of the suture to a stable anatomical feature such as the fascia pectoralis or the periosteum of a bone such as the clavicle, a rib or the sternum.
• As shown inFIG. 4A insertion points402,404 are located over the outline ofsecond rib306. The location of the insertion points over the second rib reduces the risk of injury to the patient by perforation of the pleural membrane or by damage to the perforators of the breast. As shown in the embodiment ofFIG. 4A, thelong deployment lines412,414 pass in a generally caudal and lateral direction from the insertion points402404 to the exit points406,408. Theshorter deployment line410 is approximately horizontal alongsecond rib306 providing a stable anchor point. Fixation to the fascia pectoralis may be achieved along a deployment line between an insertion and exit point or may be achieved at a single site by looping through the fascia pectoralis at that site. Fixation point or anchor as used herein should not be limited to a single point but should encompass all appropriate methods of fixating the suture to the selected stable anatomical feature. By way of example, fixation of the suture to a stable anatomical feature, to create affixation point or anchor, could be achieved using an anchoring device placed in the tissue to which the suture is attached.
• Prior to deployment of the sutures, the patient should be anaesthetized or sedated. In an open mastopexy procedure, a general anesthesia with its concomitant risks is always required. For the minimally-invasive procedure of the present invention, some patients may only require local anesthesia. Infiltration of local anesthetic along the deployment lines may be accomplished using a long small bore needle. The patient may be sedated if necessary. Some patients may still require general anesthesia to tolerate the procedure, but a significant number will not.
• FIG. 4B illustrates the fixation step. As shown inFIG. 4B, the physician makes apuncture wound422,424,426,428 at each of the previously marked insertion and exit points402,404,406,408 respectively. One advantage of a puncture or stab wound is that the wound is more likely to close and heal without stitches or scarring. The creation of the puncture wound at the insertion points allows the surgeon to more safely penetrate the required tissues without excessive force. If the skin has already been punctured using a skin puncture device, when the physician introduces the needle he may better judge the depth of the needle and the force required to enter the selected tissues. However, the needles may be introduced and exit through the skin without the prior creation of puncture wounds if the surgeon is experienced with the techniques required.
• After creation of the puncture wounds, if required, the physician insertstip122 ofneedle110 into puncture wound422 deep enough to penetrate the fascia pectoralis and directstip122 ofneedle110 through the fascia pectoralis alongdeployment line410 towards puncture wound424. Whentip122 ofneedle110 exits the fascia pectoralis through puncture wound424 the physician takes hold oftip122 and drawsneedle110 andsection128 ofsuture100 through the fascia pectoralis untilsection130 ofsuture100 lies betweenpuncture wounds422,424 alongdeployment line410 with a little ofsection130 protruding from each puncture wound.Section126 ofsuture100 is not drawn into puncture wound422, as the barbs onsection126 would obstruct motion through the tissue in that direction. Obviously, puncture wound424 could be used as the insertion point and puncture wound422 as the insertion-exit point to achieve the same result. The particular order in which the deployment is made is generally not important so long as the desired deployment pattern and orientation of the sutures can be achieved. After the fixation step,suture100 is in the position shown inFIG. 4B.Section130 ofsuture100 is anchored in the fascia pectoralis over the second rib.
• In an alternative method of introducingsuture100, a 14-gauge angiocatheter is inserted frominsertion point402 to insertion-exit point404 through the fascia pectoralis alongdeployment line410. The needle is then inserted into the catheter in a retrograde fashion alongdeployment line410 frominsertion point422 to exitpoint424. The catheter is removed when the tip of the needle has exited insertion-exit point404 and the procedure continued in the same manner described above. Advantages of using an angio-catheter are that it can be used to safely make the punctures for introduction of the needle, and can reduce the risk of injury to the patient from the tip of the needle.
• FIG. 4C illustrates the deployment step in which the physician deployssuture100 along thedeployment lines412,414. The physician first insertstip122 ofneedle110 into puncture wound424 and directstip122 ofneedle110 through the breast tissue alongdeployment line412 towards puncture wound428. Note that, in this example, puncture wound424 serves both as an insertion point and as an exit point forsuture100. During deployment, the physician may palpate the skin while introducingneedle110 to ensure thatneedle110 passes at the correct depth in the tissue alongdeployment line412.
• The deployment depth determines the type of tissues to be engaged by the suture. If the desire is to lift the breast as a whole, the depth of deployment should be through deeper fatty and fibrous parenchymal tissues of the breast gland. If however, it is desired to selectively position or contour surface features of the breast, such as the skin of the breast and the nipple-areola complex (NAC), the deployment may be along a shallower subcutaneous line. The location of the deployment lines determines the area of tissues to be engaged by a suture. The combination of the location of the deployment lines and the depth of suture deployment will determine the type of tissues engaged and the aesthetic effects that elevation of the tissue along the suture will achieve.
• Referring again toFIG. 4C, whentip122 ofneedle110 exits through puncture wound428 the physician takes hold oftip122 and drawsneedle110 andsection128 ofsuture100 through the tissue. The physician then repeats thisprocess inserting tip124 ofneedle112 through puncture wound422 alongdeployment line414 and out throughpuncture wound426. As shown inFIG. 4C, assuture100 is drawn into the tissue,loops430 and432 ofsuture100 remain external to puncturewounds422,424 untilsuture100 is pulled tight. When the suture is pulled tight,section130 ofsuture100 is anchored in the fascia pectoralis over thesecond rib306,section128 ofsuture100 has been deployed in the tissue of the patient betweenpuncture wounds424 and428 alongdeployment line412 andsection126 ofsuture100 has been deployed in the tissue of the patient betweenpuncture wounds422 and426 alongdeployment line414. At this point, the needles are no longer required and may be removed from the suture.
• Depending on the aesthetic effects desired, a physician may choose to deploy multiple sutures in the manner described above. For example, a physician may deploy one suture through deep breast structures and another suture along a shallower subcutaneous line. In this way, control of both elevation of the breast gland and elevation and contouring of the breast surface may be achieved.
• FIG. 4D illustrates the elevation step. In the elevation step, the physician applies light tension as shown byarrows440,442 tosections126 and128 ofsuture100 outside of the patient's body.Section126,128 ofsuture100 may be gripped by hemostats in order to facilitate application of tension. The application of tension to the suture maintains the suture stationary relative to the fixation points during elevation. The physician may then manually advance the patient's tissues along thebarbed portions126,128 ofsuture100 beneathdeployment lines412 and414 in the direction shown byarrows444 and446 to achieve the desired lifting effect.Barbs104 of bothsections126,128 ofsuture100 are oriented such that they yield toward the suture to allow the breast tissue to be elevated in the direction ofarrow446,444. However,barbs104 ofsuture100 grasp the tissue and prevent it from moving in the direction opposite toarrows444,446. Thus, the suture maintains the elevation of the breast tissues relative to the anchor point. An advantage of the procedures of the present invention is that the barbs are oriented so as to support the tissue along the entire length of the deployed suture. This orientation of thebarbs104 provides support and contouring of the tissues along the entire length of the deployed suture.
• During the elevation step, the physician may raise the patient to a sitting position to evaluate whether the desired amount of lifting has been achieved. The physician continues advancing the tissues along the sutures until in his judgment the desired aesthetic effect is achieved. If multiple sutures are deployed, the physician may deploy all the sutures prior to elevation. Alternatively, the physician may complete the elevation step with respect to a first suture before deciding upon the need for or placement of a second suture.
• After the desired aesthetic effect has been achieved, the physician cuts off the excess suture material and closes the insertion and exit points. In one embodiment, ends of thesuture100 in the tissue are made to lie below the surface of the skin by first depressing the skin immediately around the ends and severingsuture body102 closely against the skin. The skin will rise to cover the ends of thesuture100. The puncture wounds may be closed in any suitable conventional manner. However, it is desired that the puncture wounds be closed in a manner that leaves no scarring.
• FIGS. 5A-5L illustrate alternative deployment patterns that may be used in accordance with embodiments of the present invention. In each ofFIGS. 5A-5L the suture is deployed in a similar manner to that described above with respect toFIGS. 4A-4D. In general, as previously described, a suture is first fixated at an insertion point (which could be a single puncture wound or a deployment line) to a stable anatomical feature such as the fascia pectoralis. The two ends of the suture are then deployed in a caudal or caudal and lateral direction through the selected breast tissues. The breast tissues are then elevated relative to the fixation point by applying light tension to the suture and manually grouping and advancing the tissue along the suture. In each of these deployments,barbs104 are oriented such thatbarbs104 retain and support the elevated tissues against gravity.
• FIG. 5A illustrates one alternative embodiment of the present invention.FIG. 5A showsinsertion point501, insertion-exit point502, exit points503,504, anddeployment lines505,506,507. In this embodiment, the physician fixates a barbed suture by first deploying the suture frominsertion point501 to insertion-exit point502. The physician may direct the suture though the fascia pectoralis over the second rib providing a stable anchor point for the suture. Optionally, the suture may also be directed through the periosteum of the second rib. The physician then deploys the suture frominsertion point501 alongdeployment line506 to exitpoint503 and from insertion-exit point502 alongdeployment line507 to exitpoint504.Deployment lines506 and507 pass in a generally caudal direction to either side ofNAC309. After passingNAC309, the morelateral deployment line507 curves outward more laterally to exitpoint504, while the moremedial deployment line506 curves more medially to exitpoint503. In one embodiment, the suture is deployed at a shallow subcutaneous depth alongdeployment lines506,507 to contour the surface structures of the breast. This deployment pattern may be used to elevate the NAC with respect to the breast and also conize the breast by displacing tissues below the NAC towards the NAC.
• FIG. 5B illustrates one alternative embodiment of the present invention comprising a deployment pattern that utilizes two sutures. This deployment pattern combines the deployment pattern ofFIG. 4A with the deployment pattern ofFIG. 5A. In the combined deployment pattern, insertion-exit point404 of the first suture is shared withinsertion point501 of the second suture. Both of these deployment points will be in the same puncture wound thereby reducing the number of puncture wounds required and reducing the potential for scarring. Depending on the particular anatomy of the patient it may be desirable that a larger or greater number of the puncture wounds be shared between sutures. The fewest number of puncture wounds should be utilized to achieve the desired deployment. In the one implementation of the deployment pattern ofFIG. 5B, a first suture is deployed through deep fibrous and fatty parenchymal tissue of the breast alongdeployment lines414 and412 and a second suture is deployed through shallow subcutaneous tissues of the breast alongdeployment lines506,507. The first suture allows elevation of the breast, while the second suture allows elevation of the NAC relative to the breast and contouring of the surface of the breast. During the elevation step, tension will first be applied to the suture that has been deployed through the deep fibrous and fatty parenchymal tissue of the breast and this breast will be manually grouped and advanced along this suture until the desired breast-lift achieved. After the desired breast-lift is achieved, tension will then be applied to the suture deployed through the shallow subcutaneous tissues and the skin of the breast and the NAC will be manually grouped and advanced along this suture until the desired NAC-lift and contouring of the breast surface is achieved.
• FIG. 5C illustrates one alternative embodiment of the present invention comprising a deployment in whichinsertion point511 serves as both the insertion point and the first exit point. This reduces the number of puncture wounds required and thereby reduces the potential for scarring. The deployment pattern ofFIG. 5C, comprises insertion-exit point511, exit points512,513 anddeployment lines514,515.Insertion point511 is located proximate toclavicle304. A suture is first fixated to the fascia pectoralis proximate to the clavicle atinsertion point511. Optionally, the suture may also be directed through the periosteum of the clavicle. The suture is then deployed in a generally caudal direction alongdeployment lines514,515 to exitpoints512,513 which are located one either side ofNAC309 and cranially ofNAC309. The deployment paths flare out to either side of the breast as they approach the NAC which allows tissues to be drawn in towards thevertical line315 during the elevation step. The suture may be deployed through shallow subcutaneous tissues of the breast and this deployment to provide contouring of the surface of the breast including conization, and elevation ofNAC309 with respect to the breast.
• FIG. 5D also illustrates one alternative embodiment of the present invention comprising a deployment in whichinsertion point521 serves both as the insertion point and as the first exit point. This reduces the number of puncture wounds required and reduces the potential for scarring. The deployment pattern ofFIG. 5D comprises insertion-exit point521, exitspoints522,523 anddeployment lines524,525. Insertion-exit point521 is located proximate toclavicle304. A suture is first fixated to the fascia pectoralis proximate the clavicle at insertion-exit point521. The suture is then deployed in a generally caudally direction alongdeployment lines524,525 to exitpoints522,523 which are located one either side ofNAC309 and caudally ofNAC309 on the lower curvature of the breast. The suture may be deployed through deep fibrous and fatty parenchymal tissue of the breast to allow for elevation of the breast as a whole.
• FIG. 5E illustrates one alternative embodiment of the present invention comprising a deployment pattern combining the deployment patterns ofFIGS. 5C, 5D. As shown inFIG. 5E, insertion points511,521 may be located at the same point thereby reducing the number of puncture wounds required. In the implementation of this deployment pattern, a first suture is deployed alongdeployment lines514,515 through shallow subcutaneous tissue and a second suture is deployed through fibrous and fatty parenchymal tissue of the breast alongdeployment lines524,525. This deployment pattern allows for elevation of the breast as well as elevation of the NAC relative to the breast.FIG. 5F shows another deployment pattern combining the deployment patterns ofFIGS. 5C, 5D except that that insertion points521 and511 are not located at the same point. Instead,insertion point521 is displaced caudally ofinsertion point511. As with the two-suture deployment ofFIG. 5B, the elevation of the breast utilizing the deployment pattern ofFIGS. 5E, 5F may also be performed in two stages. First, elevation of the breast along the deep suture, and second, when the breast has been elevated, elevation of the NAC and contouring of the skin along the shallow suture.
• FIG. 5G illustrates another embodiment of the present invention. As shown inFIG. 5G, the deployment pattern comprises insertion-exit point531, exit points532,533 anddeployment lines534,535. Insertion-exit point531 is located on the upper curvature of the breast proximate to the midline. At the insertion-exit point the barbed suture may be fixated to the fascia pectoralis proximate to the sternum. After fixation, the suture is deployed caudally and laterally alongdeployment lines534 and535 towards exit points532,534 on the lower curvature of the breast. The deployment lines may pass through deep fatty and fibrous tissue of the breast parenchyma. The deployment lines allow for elevation of the breast and repositioning of the breast towards the midline.
• FIG. 5H. illustrates the deployment pattern ofFIG. 5G. in combination with a second suture. The deployment of the second suture comprises insertion-exit point541, exit points542,543 anddeployment lines544,545. Insertion-exit point541 is shown at the same location as insertion-exit point531, however it may also be displaced slightly frominsertion point541. In one implementation a second suture is fixated to the fascia pectoralis proximate the sternum atinsertion point541. The suture is then deployed caudally and laterally alongdeployment lines544,545 to exitpoints542,543. Deployment may be through subcutaneous tissues to allow for surface contouring and elevation of the NAC relative to the breast.FIG. 5I illustrates an alternative embodiment of the deployment pattern ofFIG. 5H. As shown inFIG. 5I,insertion point541 is displaced more medially thaninsertion point531 and is positioned over the sternum. The sternum provides a stable anchor point as the fascia pectoralis is attached to the front of the sternum.
• FIG. 5J illustrates an alternative deployment pattern. As shown inFIG. 5J, deployment pattern compriseinsertion point551proximate clavicle304, insertion-exit point553 and exit points552,554. The pattern is implemented by fixating the suture to the fascia pectoralis atinsertion point551 and then deploying the suture alongdeployment lines555,556 towards exit points553,554.Exit point552 is shown located at approximately the level of the third rib.Deployment line556 passes first through insertion-exit point553. At insertion-exit point553 the suture is brought out through the skin and then reintroduced through the same point. This insertion-exit point allows for the direction of the deployment line to be changed. Although the deployment lines may be curved, there is a limit to how sharp a change in needle direction may be made. If a sharp change in deployment direction is desired, an intermediate insertion-exit point may be useful in order to accomplish the change in direction.
• FIG. 5K illustrates a variation on the deployment pattern ofFIG. 5J. In this deployment, a suture is first anchored through the fascia pectoralis oversecond rib306 alongdeployment line567. Both ends of the suture are then deployed caudally to either side of NAC alongdeployment lines568,569 to exitpoints566,564 on the lower curvature of the breast. Intermediate insertion-exit points563 and565 may be utilized if necessary to achieve the desired curvature in the deployment trajectory. A suture deployed in this fashion can cradle the breast tissue allowing for elevation of the breast and NAC during the elevation step.
• FIG. 5L illustrates a deployment pattern involving three bidirectional sutures. Referring toFIG. 5L, the deployment lines for each of the three sutures are shown with a distinct line pattern. The deployment pattern for the first suture, indicated by the small-dash line, comprisesinsertion point571, insertion-exit point572, exit points573,574 anddeployment lines575,576,577. The first suture is deployed by first fixating the suture to the fascia pectoralis proximate the second rib alongdeployment line575 betweeninsertion point571 and insertion-exit point572; deploying one end of the suture caudally frominsertion point571 to exitpoint573; and deploying the other end caudally from insertion-exit point572 to exitpoint574. The deployment pattern for the second suture, indicated by the large-dash line, comprises insertion point581, insertion-exit point582, exit points583,584 anddeployment lines585,586,587. The second suture is deployed by first fixating the suture to the fascia pectoralis proximate the second rib alongdeployment line585 between insertion point581 and insertion-exit point582; deploying one end of the suture caudally from insertion point581 to exitpoint583; and deploying the other end caudally from insertion-exit point582 to exitpoint584. The deployment pattern for the third suture, indicated by the solid line, comprisesinsertion point591, exit points593,594 and deployment lines596,597. The third suture is deployed by first fixating the suture to the fascia pectoralis proximate the clavicle atinsertion point591; deploying one end of the suture caudally frominsertion point591 to exitpoint593; and deploying the other end caudally frominsertion point591 to exit point594. The first and second sutures may be deployed through deeper fatty and fibrous parenchymal tissues of the breast to allow elevation of the breast. The third suture may be deployed through shallow subcutaneous tissue to position the NAC and contour the skin of the elevated breast. In practice, all three sutures may be deployed prior to elevation. During the first stage of the elevation step, the first and second (deep) sutures will be held under tension while the breast is advanced alongdeployment lines576,586,577,587. Finally, after the desired breast elevation is achieved, the third suture will be held under tension and the skin of the breast and the NAC will be advanced along deployment line596,597 until the NAC is at the desired height and the skin of the breast has the aesthetic contour desired.
• FIGS. 6A-6D illustrate an alternative method of suture deployment for lifting the NAC relative to the breast. As shown ifFIG. 6A, the deployment pattern comprisesinsertion point602, insertion-exit points604,606,610, exit points608,612, anddeployment lines620,622,624,626 and628. As shown inFIG. 6B,suture100 is introduced atinsertion point602 and deployed alongdeployment line620 to insertion-exit point604. Bothinsertion point602 and insertion-exit point604 are located in theareolus310 surroundingnipple308.Suture100 is drawn alongdeployment line620 until theunbarbed section130 ofsuture100 is located alongdeployment line620. A little portion ofunbarbed section130 ofsuture100 may protrude frominsertion point602 and insertion-exit point604 at this stage as shown inFIG. 6B.
• As shown inFIG. 6C,suture100 is then deployed cranially frominsertion point602 alongdeployment line626 to insertion-exit point610. Likewise,suture100 is deployed cranially from insertion-exit point604 alongdeployment line622 to insertion-exit point606. The deployment is through shallow subcutaneous tissues. After deployment has reached this point, the NAC may be elevated into the desired position by drawingsuture100 upward as shown byarrows630,632, through insertion-exit points606,610. In oneembodiment NAC309 is elevated, in the direction shown byarrow634, from 1 cm to no more than 3 cm. This degree of elevation permits the NAC to be elevated without elevating the breast tissue. In an alternative embodiment, the NAC can be raised more than 3 cm and the breast may also be elevated to some extent. The barbs on the suture are oriented to restrict the suture from being drawn back through the exit points after the NAC has been elevated.
• As shown inFIG. 6D, after the NAC has been elevated by the desired amount, the suture is deployed from insertion-exit point606 alongdeployment line624 through the fascia pectoralis to exitpoint608. Likewise, the suture is deployed from insertion-exit610 alongdeployment line628 through the fascia pectoralis to exitpoint612. The deployment through the fascia pectoralis fixates the ends of the suture thereby stabilizing the elevation ofNAC309. The needles and excess suture may then be removed and the puncture wounds closed as previously described. In an alternative deployment, instead of fixatingsuture100 in the fascia pectoralis with a further caudal deployment,suture100 may be fixated to the fascia pectoralis at exit points606,610 using a surgeon's knot. If necessary or desired, a second bidirectional suture may be deployed in a similar manner to the first with the second deployment pattern displaced from the first.
• The NAC-lift procedure ofFIGS. 6A-6D may be used in combination with the deployment of other sutures to elevate the breast as shown in any of FIGS.4A-D and5A-K. A combination of breast-lift and nipple-lift using barbed sutures allows the surgeon to achieve many of the effects of a conventional mastopexy procedure without large incisions. One embodiment of a surgical procedure which combines both a breast-lift and a NAC-lift is shown in FIGS.7A-D. The deployment pattern of FIGS.7A-D employs three bidirectional sutures. The combination of three sutures in this way allows for control of breast-lift as well as NAC-lift relative to the breast and contouring of the breast to enhance conization.
• Afirst suture100 is deployed as shown inFIG. 7A. The deployment pattern comprisesinsertion point721, insertion-exit point722 and exit points723 and724.Insertion point721 is over thesecond rib 1 cm medial of naturalbreast vector line317.Insertion point722 is over thesecond rib 1 cm lateral of naturalbreast vector line317. Exit points724 are both onlowest contour line318. A fourteen gauge angiocatheter is looped betweeninsertion points721 and722 gathering up the fascia pectoralis and the posterior lamella of the breast fascia overlying the second rib. A first needle is then inserted in retrograde fashion into the tip of the angiocatheter and pushed through the angiocatheter until the tip of the needle exits the insertion point of the angiocatheter. The angiocatheter is then removed and the tip of the needle can be grasped and drawn out of the insertion point. Suture100 can then be drawn through thedeployment path725 untilunbarbed section130 lies between the twoinsertion points721,722, with a little ofunbarbed section130 remaining at each insertion point. One end of a suture is then deployed caudally alongdeployment line727 frominsertion point721 to exitpoint724. The other end of the suture is then deployed caudally alongdeployment line726 frominsertion point722 to exitpoint723. The deployment depth is selected so that the suture passes through deep fatty and fibrous parenchymal tissue in the middle of the breast gland. Note that the deployment angles out immediately belowtransthelial line314. The suture can then be drawn alongdeployment lines726,727 until no portion remains above the skin at insertion points leaving the barbed sections of the suture within the breast tissue with thebarbs104 oriented as shown.
• Asecond suture100 is then deployed as shown inFIG. 7B. The deployment pattern comprisesinsertion point711, insertion-exit point712 and exit points713 and714. In this deployment, insertion points711 and722 share the same location, reducing the number of punctures necessary.Insertion point712 is placed over the second rib betweeninsertion point722 andvertical line315 at a position selected based on the elevation axis desired. A fourteen gauge angiocatheter is looped betweeninsertion points711 and712 gathering up the fascia pectoralis and the posterior lamella of the breast fascia overlying the second rib. A first needle is then inserted in retrograde fashion into the tip of the angiocatheter and pushed through the angiocatheter until the tip of the needle exits the insertion point of the angiocatheter. The angiocatheter is then removed and the tip of the needle can be grasped and drawn out of the insertion point. Suture100 can then be drawn through thedeployment path715 untilunbarbed section130 lies between the twoinsertion points711,712, with a little ofunbarbed section130 remaining at each insertion point. One end of a suture is then deployed caudally alongdeployment line717 frominsertion point711 to exitpoint714. The other end of the suture is then deployed caudally alongdeployment line716 frominsertion point712 to exitpoint713. The deployment depth is selected so that the suture passes through deep fatty and fibrous parenchymal tissue in the middle of the breast gland. Note that the deployment angles out immediately belowtransthelial line314. The suture can then be drawn alongdeployment lines716,717 until no portion remains above the skin at insertion points leaving the barbed sections of the suture within the breast tissue with thebarbs104 oriented as shown. The second suture, may alternatively be deployed at a more shallow depth if sufficient elevation is expected with the first suture, or more contouring of the breast surface is desired.
• After the deployment of the first two sutures as shown inFIGS. 7A, 7B, the breast may be elevated by grouping and advancing the breast tissue along thelong deployment lines716,717,726,727 of the first and second bidirectional (deep) sutures while maintaining tension on the free ends of the first and second bidirectional (deep) sutures. The elevation step is performed with the patient in an upright position in order to gauge the aesthetic effects achieved. Because these sutures are deployed in the deeper fatty and fibrous parenchymal tissues of the breast, the grouping and advancing of the breast tissue elevates the breast as a whole towardssecond rib306.
• A third bidirectional suture is then deployed as shown inFIG. 7 C. The deployment pattern comprisesinsertion point731, insertion-exit point732,733 and734.Insertion point731 and insertion-exit point732 are located inNAC309 abovenipple308. Insertion-exit points733 and734 may be located over the third rib on vectors fromNAC309 along whichNAC309 is desired to be positioned. The NAC will have moved during the elevation of the breast gland and so the location of these insertion-exit points may be selected after breast elevation to achieve the desired location ofNAC309 on the elevated breast. As shown inFIG. 7C, the third suture is deployed betweeninsertion point731 and insertion-exit point732 alongdeployment line735. A needle is first inserted atinsertion point731 and pushed through the tissues of the NAC and out insertion-exit point732. The deployment depth is through shallow structures of the NAC but the deployment depth is deep enough to avoid extrusion of the suture over time.Suture100 is then drawn alongdeployment line735 until theunbarbed section130 ofsuture100 is located alongdeployment line735 within the tissues of the NAC. The suture is then deployed cranially alongdeployment lines736,737 to exitpoints733,734 proximate the third rib. The deployment depth is controlled such that the third suture is deployed through shallow subcutaneous tissue.
• The NAC may then be repositioned relative to the breast. This is achieved by applying tension to the third bidirectional suture and pulling the suture up through the insertion-exit points733,734 proximate the third rib. When the desired NAC position has been achieved the suture is deployed in a downward direction from insertion-exit points733,734 to exitpoints736,737. The suture penetrates through the fascia pectoralis between insertion-exit points733,734 and exit points736,737 thus anchoring the suture to a stable anatomical feature in order to maintaining the desired position of the NAC.
• The position of the breast tissues on the three sutures may be adjusted by the physician with the patient in an elevated position until the physician, in his or her judgment, has achieved the aesthetic result desired. After the elevation is complete to the physician's satisfaction, the free ends of the suture may be cut off and the exit wounds closed. This embodiment of the present invention, by utilizing a combination of three sutures, allows for control of breast-lift, as well as positioning the NAC relative to the breast and contouring the tissues above the NAC.
• The foregoing description of embodiments of the present invention has been provided for the purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise forms disclosed. The deployment patterns described may be modified and combined in accordance with the principles described to provide the breast and NAC elevation, medial displacement and contouring desired in a particular case in light of the patient's anatomy. Many embodiments were chosen and described in order to explain the principles of the invention and its practical application, thereby enabling others skilled in the art to understand the invention for various embodiments and with various modifications that are suited to the particular use contemplated. It is intended that the scope of the invention be defined by the claims and their equivalents.

Claims (27)

1. A method of performing a procedure to reposition portions of a breast having a nipple-areola complex (NAC) using a suture including a plurality of barbs, the barbs, on a first portion of the suture between a first end of the suture and a first axial location on the suture for permitting movement of the suture through tissue in a direction of movement of the first end and preventing movement of the suture through tissue in a direction opposite the direction of movement of the first end, and the barbs on a second portion of the suture between a second end of the suture and a second axial location on the suture permitting movement of the suture through tissue in a direction of movement of the second end and preventing movement of the suture through tissue in a direction opposite the direction of movement of the second end, the method comprising the steps of:

(a) inserting the first end of the suture through the skin of a patient at a first fixation point located cranially of the inframammary fold;

(b) causing the suture to engage a stable anatomical feature accessible from the fixation point;

(c) deploying the first portion of the suture through breast tissue along a first deployment path to a first exit point located caudally of the fixation point and medially of the NAC;

(d) inserting the first end of the suture through the skin of the patient at the first exit point;

(e) deploying the first portion of the suture through breast tissue along a second deployment path to a second exit point located laterally of the NAC;

(f) inserting the second end of the subject through the skin of a patient at the first fixation point;

(g) deploying the second portion of the suture through breast tissue along a third deployment path to a third exit point located caudally of the fixation point;

(h) advancing the breast tissue caudally and medially relative to the first portion of the suture.

2. The method ofclaim 1, wherein step (a) comprises inserting the first end of the suture through the skin of a patent at a first fixation point located cranially of the inframammary fold and close to one of a rib and a clavicle.

3. The method ofclaim 2, wherein step (b) comprises causing the suture to engage a fascia pectoralis accessible from the first fixation point.

4. The method ofclaim 1, wherein step (a) comprises inserting the first end of the suture through the skin of a patient at a first fixation point located cranially of the inframammary fold and close to a second rib.

5. The method ofclaim 1, wherein step (g) comprises deploying the second portion of the suture to a third exit point located caudally of the fixation point and cranially of the NAC.

6. The method ofclaim 1, wherein step (g) comprises deploying the second portion of the suture to a third exit point located caudally of the fixation point and caudally of the NAC.

7. The method ofclaim 6, wherein:

step (c) comprises deploying the first portion of the suture along a first deployment path located medially of the NAC; and

step (g) comprises deploying the second portion of the suture through breast tissue along a third deployment path located laterally of the NAC.

8. The method ofclaim 1, wherein step (g) comprises deploying, the second portion of the suture through breast tissue along a third deployment path to a third exit point located caudally and laterally of the NAC; and

(g2) inserting the second end of the suture through the skin of the patient at the third exit point; and

(g3) deploying the second portion of the suture through breast tissue along a fourth deployment path to a fourth exit point located medially of the NAC.

9. The method ofclaim 1, wherein step (f) further comprises:

(f1) deploying the second portion of the suture through tissue along an intermediate deployment path and out through an intermediate exit point located cranially of the inframammary fold; and

(f2) reinserting the second end of the suture through the skin of a patient at the intermediate exit point.

10. The method ofclaim 1, wherein:

step (c) comprises deploying the first portion of the suture through shallow subcutaneous tissue so as to allow elevation of the NAC towards the first fixation point; and

step (e) comprises deploying the first portion of the suture through shallow subcutaneous tissue so as to allow repositioning of the NAC medially.

11. The method ofclaim 1, wherein:

step (c) comprises deploying the first portion of the suture through deep parenchymal tissue so as to allow elevation of the breast and NAC towards the first fixation point; and

step (e) comprises deploying the first portion of the suture through deep parenchymal tissue so as to allow contouring of the breast.

12. A suture implanted in tissues of a breast to maintain the tissues of the breast having a nipple-areola complex (NAC) in an elevated position wherein the suture comprises a first end, a second end, an intermediate portion, and a first barbed portion between the first end and the intermediate portion and a second barbed portion between the second end and the intermediate portion and wherein:

the intermediate, portion of the suture is engaged with a stable anatomical feature located cranially of the inframammary fold;

the first barbed portion of the suture is engaged with tissues of the breast located along a line extending first caudally through tissues of the breast medial of the NAC from the stable anatomical feature and then curving laterally through tissues of the breast located caudally of the NAC, the barbs on the first portion of the suture preventing the tissues of the breast from moving caudally relative to the stable anatomical feature; and

the second barbed portion of the suture is engaged with tissues of the breast located along a line extending caudally through tissues of the breast from the stable anatomical feature, the barbs of the second portion of the suture preventing the tissues of the breast from moving caudally relative to the stable anatomical feature.

13. The suture ofclaim 12, wherein the intermediate portion of the suture is engaged with the fascia pectoralis.

14. The suture ofclaim 13 wherein the first barbed, portion of the suture is engaged with tissues of the breast located along a line extending caudally through tissues of the breast located medially of the NAC.

15. The suture ofclaim 11 herein the second barbed portion of the suture is engaged with tissues of the breast located along a line extending caudally through tissues of the breast located laterally of the NAC.

16. The suture ofclaim 12, wherein the intermediate portion of the suture is engaged with the fascia pectoralis in the region of one of the first rib, the second rib and the clavicle.

17. The suture ofclaim 12, wherein:

the first barbed portion of the suture is engaged with shallow subcutaneous tissues to reposition a surface feature of the breast.

18. The suture ofclaim 12, wherein the first barbed portion of the suture is engaged with deep parenchymal tissues of the breast so to position the breast.

19. The suture ofclaim 12, wherein the second barbed portion of the suture is engaged with tissues of the breast located along a line that first extends caudally and laterally of the NAP and then curves medically tinder the NAC.

20. A method of performing a procedure to reposition portions of a breast having a nipple-areola complex (NAC) using a suture including a plurality of barbs, the barbs on a first portion of the suture between a first end of the suture and a first axial location on the suture for permitting movement of the suture through tissue in a direction of movement of the first end and preventing movement of the suture through tissue in a direction opposite the direction of movement of the first end, and the barbs on a second portion of the suture between a second end of the suture and a second axial location on the suture permitting movement of the suture through tissue in a direction of movement of the second end and preventing movement of the suture through tissue in a direction opposite the direction of movement of the second end, the method comprising the steps of:

(a) deploying the first portion of the suture caudally through breast tissue from a first fixation point located cranially of the inframammary fold along a first deployment path passing medially of the NAC and then curving laterally under the NAC to a first exit point located on the breast located laterally and caudally of the NAC;

(b) deploying the second portion of the suture caudally through breast tissue along a second deployment path from a second fixation point located cranially of the inframammary fold to a second exit point located on the breast caudally of the second fixation point; and

(c) advancing the breast tissue cranially relative to the first portion of the suture to reposition the breast tissue towards the first and second fixation points.

21. The method ofclaim 20, further comprising engaging the suture with a stable anatomical feature adjacent the first fixation point.

22. The method ofclaim 20, further comprising engaging the suture with a fascia pectoralis adjacent the first fixation point.

23. The method ofclaim 22, wherein step (a) comprises deploying the first portion of the suture from a first fixation point located close to one of a first rib, a second rib and a clavicle.

24. The method ofclaim 20 wherein step (a) comprises deploying the first portion of the suture through shallow subcutaneous breast tissue so as to allow elevation of the NAC towards the first fixation point.

25. The method ofclaim 20 wherein step (a) comprises deploying the first portion of the suture through deep parenchymal breast tissue so as to allow elevation of the breast and NAC towards the first fixation point.

26. The method ofclaim 20, wherein step (b) comprises deploying the second portion of the suture from a second fixation point located in the same place as the first fixation point.

27. The method ofclaim 12, wherein step (b) comprises deploying the second portion of the suture laterally through breast tissue from the first fixation point to the second fixation point prior to deploying the second portion of the suture caudally through breast tissue along a second deployment path from the second fixation point to a second exit point located on the breast caudally of the second fixation point.

Images