The Key of Pocket Dissection in Transaxillary Dual-plane Breast Augmentation: How to Control Inferior Malposition of Smooth Implants.

BACKGROUND: Inferior implant malposition after breast augmentation is the second most common reason for revision surgery. This article introduces the new concept of dual-plane pocket formation in transaxillary breast augmentation to prevent inferior implant malposition by preserving the continuity of the superficial layer of the deep pectoralis fascia. METHODS: Patients who underwent transaxillary endoscopic breast augmentation performed from January 2017 to December 2019 were retrospectively reviewed. With the aid of the endoscope, dissection proceeded. During pectoralis muscle origin detachment, the superficial layer of deep pectoralis fascia was preserved. After making the pocket, silicone gel implants were inserted. A retrospective chart review was done to collect data on postoperative complications. RESULTS: A total of 251 patients were performed, and the mean follow-up time was 20.6 months. In a total of 28 cases of complications (9.6%), there were 2 cases of reoperations. In a total of three patients (1.2%) of implant malposition, one patient (0.4%) developed mild bilateral bottoming-out deformity. CONCLUSIONS: Meticulous dissection by endoscopy could avoid the destruction of the superficial layer of the deep pectoralis fascia during pocket dissection and produce an intact fascial system with its own continuity at the inframammary fold (IMF). A well-controlled envelope over the implant and a supporting structure underneath it are important in breast augmentation to prevent inferior implant malposition.

Retrospective multicenter cohort analysis of 621 cases of BellaGel silicone breast implants with study of physicochemical properties and surface topography.

This study aimed to assess the effectiveness and safety of BellaGel implants after implantation in Asian women and inform surgeons of another option for use in breast augmentation and reconstruction. This study was conducted in eight hospitals from November 27, 2015 to April 30, 2018. All patients underwent augmentation mammoplasty or implant-based breast reconstruction with BellaGel implants. Complication rates were compared between groups, and the cumulative hazard function was compared using the Kaplan-Meier survival analysis. Implants were grouped by surface type, and the cumulative hazard functions of total complication cases were compared. The biomechanical properties of the BellaGel implant and other company representative implants were tested using a mechanical testing machine, and surface topography was analyzed using a 3D laser scanning confocal microscope. There was a significant difference in the incidence of complications between the reconstruction (17.1%) and augmentation (4.7%) groups, but no significant difference in the complication rates of each group. There was no difference in the reoperation or revision rates between the groups. The log rank test showed a statistically significant difference in cumulative hazard function between the groups. Among the three types of implants (smooth, textured, and microtextured), the microtextured type had the lowest complication rate. The BellaGel microtexture implant had the highest maximal tensile load and displacement value. The BellaGel and Silksurface implants had the highest stored energy, although there was no significant difference. BellaGel implants can serve as a criterion for the selection of safe and effective implants among currently available implants.

Axillary endoscopic subglandular tunneling approach for types 2 and 3 dual-plane breast augmentation.

BACKGROUND: Dual-plane techniques offer excellent pocket locations for breast augmentation. Traditional techniques require incisions in the inframammary or periareolar crease, which are rarely accepted in the authors' department because of visible scars on the breast. Therefore, the authors developed a transaxillary approach for dual-plane procedures using an endoscope. METHODS: During a period of 36 months between April 2009 and March 2012, 89 consecutive patients with small breasts were treated surgically. They underwent transaxillary types 2 or 3 dual-plane breast augmentation as outpatients. For the axillary endoscopic subglandular tunneling approach (AESTA), a long subglandular tunnel was created along the lateral portion of the pectoralis major muscle to reach the nipple-areolar complex. The type 2 dual-plane technique was applied in 67 patients, and the type 3 technique was used in 22 patients. RESULTS: The mean age of the patients was 37.5 years (range 31-48 years), and the mean postoperative follow-up period was 11 months (range 7-42 months). Good surgical outcomes were obtained, and the procedure was reproducible. CONCLUSIONS: The use of AESTA allowed the authors to achieve types 2 and 3 dual-plane breast augmentation through a transaxillary incision. They believe that AESTA can yield constant and satisfactory outcomes similar to the inframammary and periareolar approaches. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.