**5. Wound closure**

Wound closure is performed in two planes by a single surgeon. The deep plane consists of suturing the dermis to the costal perichondrium in a continuous fashion. The superficial plane is sutured utilizing a running barbed suture through the de-epithelialized dermis, allowing the apposition of the epidermis with minimal tension [48] (**Figure 5**).

#### **Figure 6.**

*(A, B, C) preoperative photo of a 45-year-old female patient presenting with bilateral breast hypertrophy and moderate ptosis. The patient underwent a P.a.L.M. procedure using a vertical scar with NAC elevation of 10 cm on the right breast and 10 cm on the left, liposuction of 650 mL on the right breast and 650 mL on the left breast, glandular resection 150 g on both breasts. (D, E, F, G) results at 24 months postoperatively.*

Video 2 shows the surgical procedure. Video 2 PALM surgery: https://youtu.be/BC2R5iYR7Fo Clinical cases are shown in **Figures 6**–**11**.

#### **Figure 7.**

*(A, B, C) preoperative photos of a 49-year-old female patient presenting with bilateral breast gigantomastia, breast asymmetry and ptosis with distance from nipple-to-sternal notch of 52 cm on the right breast and 33 cm on the left. The patient underwent a P.a.L.M. procedure using a vertical scar with NAC elevation of 16 cm on the right breast and 12 cm on the left, liposuction of 800 mL on the right breast and 400 mL on the left breast, glandular resection of 260 g of the right breast and 150 g from the left. (D, E, F, G) results at 36 months postoperatively.*

*Power-Assisted Liposuction Mammaplasty (PALM): A Short Scar Mammaplasty… DOI: http://dx.doi.org/10.5772/intechopen.98816*

#### **Figure 8.**

*(A) Preoperative photo of a 41-year-old female patient presenting with bilateral breast gigantomastia with asymmetry, breast ptosis and massive weight loss, with a distance from nipple-to-sternal notch of 37 cm on the right breast and 37 cm on the left. The patient underwent a P.a.L.M. procedure using a short T scar with NAC elevation of 17 cm on the right breast and 19 cm on the left, liposuction of 1450 mL on the right breast and 1650 mL on the left breast, glandular resection of 100 g of the right breast and 100 g from the left. (B, C) per-operative views. (D, E, F) results at 48 months postoperatively.*

#### **6. Postoperative care**

A drain is left in place at the lower area of each breast for 48 hours or until the drainage becomes serosanguinous or serous and decreases in the daily average amount.

Gauze dressing is utilized to cover the breast wounds. One to two days postoperatively, the patient is discharged from the hospital with instructions to wear a compression bra for 6 weeks. Then, annually, patients receive postoperative breast imaging.

#### **Figure 9.**

*(A) Preoperative photo of a 53-year-old female patient presenting with bilateral breast gigantomastia, severe ptosis and massive weight loss, with a distance from nipple-to-sternal notch of 35 cm on the right breast and 38 cm on the left. The patient underwent a P.a.L.M. procedure using a short T scar with NAC elevation of 14 cm on the right breast and 17 cm on the left, liposuction of 950 mL on the right breast and 1100 mL on the left breast, glandular resection of 150 g of the right breast and 150 g from the left. (B, C) per-operative views. (D, E, F) results at 36 months postoperatively.*

*Power-Assisted Liposuction Mammaplasty (PALM): A Short Scar Mammaplasty… DOI: http://dx.doi.org/10.5772/intechopen.98816*

#### **Figure 10.**

*(A) Preoperative photo of a 56-year-old female patient presenting with massive ptosis and massive weight loss. The patient underwent a P.a.L.M. procedure using a vertical scar with NAC elevation of 25 cm on the right breast and 29 cm on the left, liposuction of 2000 mL on the right breast and 2000 mL on the left breast, glandular resection of 200 g of the right breast and 400 g from the left. (B, C, D) per-operative views. (E, F, G) results at 24 months postoperatively.*

#### **Figure 11.**

*(A, B, C) preoperative photos of a 50-year-old female patient presenting with gigantomastia, severe ptosis and massive weight loss, with a distance from nipple-to-sternal notch of 46 cm on the right breast and 46 cm on the left. The patient underwent a P.A.L.M. procedure using a short T scar with NAC elevation of 20 cm on the right breast and 20 cm on the left, liposuction of 2500 mL on the right breast and 2500 mL on the left breast, glandular resection of 120 g of the right breast and 150 g from the left. (D, E, F, G) results at 36 months postoperatively.*

*Power-Assisted Liposuction Mammaplasty (PALM): A Short Scar Mammaplasty… DOI: http://dx.doi.org/10.5772/intechopen.98816*
