MINIMALLY-INVASIVE MASTOPLASTY PROCEDURE USING MULTIPLE BARBED SUTURES AND APPARATUS

1 . A method of performing a procedure to reposition portions of a breast having a nipple-areola complex (NAC) using first and second sutures each including a plurality of barbs, the barbs on a first portion of each 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 of a second portion of each 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:

(a1) inserting the first end of the first, suture through the skin of a patient at a first fixation point located cranially of the inframammary fold;

(b1) causing the first suture to engage a stable anatomical feature accessible from the first fixation point;

(c1) deploying the first portion of the first suture through breast tissue along a first deployment path to a first exit point located caudally of the first fixation point;

(d1) deploying the second portion of the first suture through breast tissue along a second deployment path to a second exit point located caudally of the first fixation point;

(a2) inserting the first end of the second suture through the skin of a patient at a second fixation point located cranially of the inframammary fold;

(b2) causing the second suture to engage a stable anatomical feature accessible at the second fixation point;

(c2) deploying the first portion of the second suture through breast tissue along a third deployment path from the second point to a third exit point located caudally of the second fixation point;

(d2) deploying the second portion of the second suture through breast tissue along a fourth deployment path from the second fixation point to a fourth exit point located caudally of the fixation point; and

(e) manually advancing the soft tissue relative to the first portion of the first suture, the second portion of the first suture, the first portion of the second suture, the second portion of the second suture to elevate tissues of the breast towards the first fixation point and the second fixation point.

2 . The method of claim 1 , wherein:

step (b1) comprises causing the first portion of the first suture to engage a fascia pectoralis; and

step (b2) comprises causing the first portion of the second suture to engage the fascia pectoralis

3 . The method of claim 2 , wherein:

step (c1) comprises deploying the first portion of the first suture along a first deployment path through breast tissue to a first exit point located caudally of the first fixation point and medially of the NAC; and

step (d1) comprises deploying the second portion of the first suture through breast tissue along a second deployment path to a second exit point located caudally of the first fixation point and laterally of the NAC.

4 . The method of claim 3 wherein step (a1) comprises inserting the first end of the first suture through the skin of a patient at a first fixation point located close to one of the first rib, the second rib and the clavicle.

5 . The method of claim 4 , wherein:

step (c1) comprises deploying the first portion of the first suture along a first deployment path through breast tissue to a first exit point located medially of the NAC; and close to the lowest pre-surgery contour of the breast; and

step (d1) comprises deploying the second portion of the first suture through breast tissue along a second deployment path to a second exit point located laterally of the NAC and close to the lowest pre-surgery contour of the breast.

6 . The method of claim 5 , wherein:

step (c1) comprises deploying the first portion of the first suture along a first deployment path through shallow subcutaneous tissue so as to allow elevation of the NAC towards the fixation point; and

step (d1) comprises deploying the second portion of the first suture through shallow subcutaneous tissue so as to allow elevation of the NAC towards the fixation point.

7 . The method of claim 6 , wherein:

step (c2) comprises deploying the first portion of the second suture along a first deployment path through deep parenchymal tissue so as to allow elevation of the breast and NAC towards the fixation point; and

step (d2) comprises deploying the second portion of the second suture through deep parenchymal tissue so as to allow elevation of the breast and NAC towards the fixation point.

8 . The method of claim 1 , wherein:

step (c1) comprises deploying the first portion of the first suture along a first deployment path through shallow subcutaneous tissue so as to allow elevation of the NAC towards the fixation point; and

step (d1) comprises deploying the second portion of the first suture through shallow subcutaneous tissue so as to allow elevation of the NAC towards the fixation point.

9 . The method of claim 1 , wherein:

step (c1) comprises deploying the first portion of the first suture along a first deployment path through deep parenchymal tissue so as to allow elevation of the breast and NAG towards the fixation point; and

step (d1) comprises deploying the second portion of the first suture through deep parenchymal tissue so as to a allow elevation of the breast and NAC towards the fixation point.

10 . The method of claim 1 , wherein:

step (c1) comprises deploying the first portion of the suture along a first deployment path, which curves away from the NAC caudally of the NAC, through breast tissue to a first exit point located medially of the NAC; and

step (d1) comprises deploying the second portion of the suture through breast tissue along a second deployment path, which curves away from the NAC caudally of the NAC, to a second exit point located laterally of the NAC.

11 . The method of claim 1 , wherein step (b2) comprises inserting the first end of the second suture through the skin of a patient at a second fixation point located in the same place as the first fixation point.

12 . The method of claim 1 , wherein step (b1) further comprises:

causing the first end of the first suture to exit through the skin of the patient at a first intermediate point lateral of the first fixation point; and

reinserting the first end of the first suture thorough the skin of the patient at the first intermediate point.

13 . The method of claim 1 , wherein step (b2) comprises inserting the first end of the second suture through the skin of a patient at a second fixation point located in the same place as one of the first fixation point and the first intermediate point.

14 . The method of claim 1 , further using a third suture including a plurality of barbs extending from the periphery of the suture, 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 the tissue in a direction of movement of the first end and preventing movement of the suture relative to the 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 the tissue in a direction of movement of the second end and preventing movement of the suture relative to the tissue in a direction opposite the direction of movement of the second end, wherein the method comprises:

(a3) insetting the first end of the third suture through the skin of a patient at a third fixation point located cranially of the inframammary fold;

(b3) causing the third suture to engage a stable anatomical feature accessible at the third fixation point;

(c3) deploying the first portion of the third sure through breast tissue along a fifth deployment path from the third fixation point to a fifth exit point located caudally of the third fixation point;

(d3) deploying the second portion of the third suture through breast tissue along a sixth deployment path from the third fixation point to a sixth exit point located caudally of the third fixation point; and

(e3) manually advancing the soft tissue relative to the first portion of the third suture and the second portion of the third suture to elevate tissues of the breast towards the third fixation point.

15 . A method of performing a procedure to reposition portions of a breast having a nipple-areola complex (NAC) using a first and second suture each including a plurality of barbs, the barbs on a first portion of each 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 each suture between a second end of the suture and a second axial location on the suture which is less than the distance from the second end to the first axial location 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:

(a1) deploying the first portion of the first suture caudally through breast tissue along a first deployment path from a first fixation point located cranially of the inframammary fold to a first exit point located on the breast caudally of the NAC;

(b1) deploying the second portion of the first 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 NAC;

(a2) deploying the first portion of the second suture caudally through breast tissue along a first deployment path from a third fixation point located cranially of the inframammary fold to a third exit point located on the breast caudally of the NAC;

(b2) deploying the second portion of the second suture caudally through breast tissue along a second deployment path from a fourth fixation point located cranially of the inframammary fold to a fourth exit point located on the breast caudally of the NAC; and

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

16 . The method of claim 15 , further comprising using a third 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 which is less than the distance from the second end to the first axial location 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:

(a3) deploying the first portion of the third suture caudally through breast tissue along a fifth deployment path from a fifth fixation point located cranially of the inframammary fold to a fifth exit point located on the breast caudally of the NAC;

(b3) deploying the second portion of the third suture caudally through breast tissue along a sixth deployment path from a sixth fixation point located cranially of the inframammary fold to a sixth exit point located on the breast caudally of the NAC; and

(c3) advancing the breast tissue cranially relative to the first portion of the second suture and the second portion of the second suture to reposition the breast tissue towards the third and fourth fixation points.

17 . The method of claim 15 , further comprising engaging the fascia pectoralis with the first suture and the second suture at the first fixation point and second fixation point.

18 . The method of claim 15 , further comprising engaging a stable anatomical feature adjacent the first fixation point with the first portion of the first suture and engaging a stable anatomical feature adjacent the second fixation point with the first portion of the second suture.

19 . The method of claim 15 , wherein:

step (a1) comprises deploying the first portion of the first suture caudally from a first fixation point located close to one of a first rib, a second rib a the clavicle; and

step (a2) comprises deploying the first portion of the second suture caudally from a first fixation point located close to one of a first rib, a second rib a the clavicle.

20 . The method of claim 15 , wherein:

step (a1) comprises deploying the first portion of the first suture along a first deployment path to a first exit point located on the breast caudally and medially of the NAC; and

step (b1) comprises deploying the second portion of the first suture 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 and laterally of the NAC.

21 . The method of claim 15 , wherein:

step (a1) comprises deploying the first portion of the first suture to a first exit point located on the breast caudally and medially of the NAC and close to the lowest pre-surgery contour of the breast; and

step (b) comprises deploying the second portion of the first suture to a second exit point located on the breast caudally and laterally of the NAC and close to the lowest pre-surgery contour of the breast.

22 . The method of claim 15 wherein:

step (a1) comprises deploying the first portion of the first suture through shallow subcutaneous breast tissue so as to allow elevation of the NAC towards the first fixation point; and

step (b1) comprises deploying the second portion of the suture through shallow subcutaneous breast tissue so as to allow elevation of the NAC towards the second fixation point.

23 . The method of claim 22 wherein:

step (a2) comprises deploying the first portion of the second suture caudally through deep parenchymal breast tissue so as to allow elevation of the breast and NAC towards the first fixation point; and

step (b2) comprises deploying the second portion of the second suture caudally through deep parenchymal breast tissue so as to allow elevation of the breast and NAC towards the second fixation point.

24 . The method of claim 15 , wherein step (b2) comprises deploying the second portion of the second suture from a third fixation point located in the same place as one of the first fixation point and second fixation.

25 . A suture implant system positionable in tissues of a breast to maintain the tissues of the breast having a nipple-areola complex (NAC) in an elevated position wherein a first suture and a second suture of the system each comprise 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 first suture and the second suture are engaged with a stable anatomical feature located cranially of the inframammary fold;

the first barbed portion of the fist suture and the second suture are engaged with tissues of the breast located along a line extending caudally through tissues of the breast from the stable anatomical feature, the barbs on the first portion of the first suture and the second suture are preventing the tissues of the breast from moving caudally relative to the stable anatomical feature; and

the second barbed portion of the first suture and the second suture are engaged with tissues of the breast located along a line extending caudally through tissues of the breast from the stable anatomical feature, the barbs on the second portion of the first suture and the second suture prevent the tissues of the breast from moving caudally relative to the stable anatomical feature.

26 . The suture of claim 25 , wherein the intermediate portion of the first suture and the second suture are engaged with the fascia pectoralis.

27 . The suture of claim 25 wherein:

the first barbed portion of the first suture and the second suture are engaged with tissues of the breast located along a line extending caudally through tissues of the breast located medially of the NAC; and

the second barbed portion of the first structure and the second suture are engaged with tissues of the breast located along a line extending caudally through tissues of the breast located laterally of time NAC.

28 . The suture of claim 25 , wherein the intermediate portion of the first suture and the second suture are engaged with the fascia pectoralis in the region of one of the first rib, the second rib and the clavicle.

29 . The suture of claim 25 , wherein the first end of the first suture and the second suture and the second end of the first suture and the second suture are close to the lowest pre-surgery contour of the breast.

30 . The suture of claim 25 , wherein:

the first barbed portion of the first suture and the second suture are engaged with shallow subcutaneous tissues of the breast located along a line extending caudally through tissues of the breast from the stable anatomical feature, the barbs on the first portion of the first suture and the second suture preventing the shallow subcutaneous tissues of the breast from moving caudally relative to the stable anatomical feature; and

the second barbed portion of the first suture and the second suture are engaged with shallow subcutaneous tissues of the breast located along a line extending caudally through tissues of the breast from the stable an anatomical feature, the barbs on the second portion of the first suture and the second suture preventing the shallow subcutaneous tissues of the breast from moving caudally relative to the stable anatomical feature.

31 . The suture of claim 25 , wherein:

the first baited portion of the first suture and the second suture are engaged with deep parenchymal tissues of the breast located along a line extending caudally through tissues of the breast from the stable anatomical feature, the barbs on the first portion of the first suture and the second suture, preventing the deep parenchymal tissues of the breast from moving caudally relative to the stable anatomical feature; and,

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

32 . The suture of claim 25 , wherein the first barbed portion and first suture and the second suture and the second barbed portion first suture and the second suture curve away from the NAC caudally of the NAC.