And with this, the surgeon calls, “Scalpel”. Luz passes the scalpel to the surgeon’s right hand and a gauze sponge to his left. He begins to make a 4 cm incision in the high axilla, about 1 cm from the lateral border of the pectoralis major muscle. He used the sponge to provide pressure over any bleeding, and the cautery once or twice for a moment. The incision is deepened until the fat is exposed. Shallow dissection proceeds about 3 cm toward the lateral border of the pectoralis major muscle.

The surgeon watches as he performs dissection until he reaches the pectoral fascia. He then opens the fascia and accesses the layer between the pectoralis major and minor. Hemostasis is achieved through the cautery for the lateral thoracic vessels is achieved. When the clavipectoral space was ready through the axillary window, the endoscope was introduced. Sharp dissection, with electrocautery, through the endoscope was then begun, working from the superomedial to the inferomedial to the inferolateral, and up to the lateral parts in a clockwise fashion.

After confirming the loose areolar tissues between the muscles, the endoscope proceeded parallel to the clavicle toward the midsternum, with hemostasis achieved because of the gradual and purposeful movement of the endoscope.

The endoscope was then moved from the superomedial pocket to the inferomedial pocket. The sharp dissection was started from the sternocostal junction at the level of the inferior areolar margin. From medial to lateral, the costal origin was completely divided by electrocautery, with the muscle stumps coagulated.

Dissection was in progress from the inferolateral region toward the lateral part of the new inframammary crease in a clockwise direction and carefully continued until the lateral edge of the pectoralis minor muscle and the superficial layer of pectoral fascia were exposed.

The surgeon then moved to Mollie’s left side and repeat the procedure to make the left sided pocket.

After creating the left side pocket, he returns to Mollie’s right side. He checks with the endoscope that there is no additional bleeding, assuring a bloodless pocket. Luz begins to irrigate the right pocket with an antibiotic solution as the surgeon performs the checks on the left pocket with the endoscope. Luz then irrigates that pocket. As the solution was suctioned from Mollie’s pockets, it is checked for the presence of blood. There is none, and the surgery progresses.

Using a large retractor, the surgeon pulls the right pocket open. Luz passes the implant, which he then places through the pocket and under the breast. He then switches sides and places the implant in the pocket. The surgeon, Luz, Kelly, and Dayna all look at the breasts to assure they are in the correct position. The cameraman takes a close look. “Wow, that really did make a difference. They look amazing.”

Mollie is then lifted into the semi-fowlers position and the team again checks her new breasts. Everything still looks simply perfect and she is lowered back to supine again. The subcutaneous tissue is closed with absorbable sutures, then the skin is closed with fine suture with the goal of having little to no visible scar in a year. Mollie is lifted back into the semi-fowlers position. Dressings are placed over both wounds and her new breasts are wrapped in ace bandages. Almost three hours since arriving in the operating room, the breast procedure is completed. She is returned to the supine position and the drapes are removed to prepare for the liposuction procedure.