The Use of a Retromammary Adipofascial Flap in Breast Augmentation for Patients with Thin Soft Tissue.

BACKGROUND: In patients with a thin soft tissue breast envelope, lower pole implant palpability is a postoperative sequela that concerns patients. Anatomically, the lower aspect of the breast near the inframammary fold lacks sufficient soft tissue to cover the breast implant after augmentation. METHODS: A transareolar incision was made, and subcutaneous dissection was performed. The dissection first proceeded caudally to the lower aspect to the breast parenchyma. The dissection then changed direction and moved cephalad to the mid breast or nipple region. The fatty tissue and pectoralis muscle fascia were cut transversely at this level, and the dissection was reversed caudally in a subfascial plane to the new inframammary fold region. This maneuver created a retromammary adipofascial flap. RESULTS: A total of 368 breast augmentations were performed in 184 patients. Breast implants were inserted in the subfascial plane in 40 patients (21.7%) and in the subpectoral-subfascial plane in 144 patients (78.3%). A total of 368 breast implants were inserted, including 140 smooth cohesive silicone implants (38.0%), 2 textured round implants (0.5%), and 226 anatomic-type implants (61.5%). A cadaveric dissection revealed that a retromammary adipofascial flap measuring 3-4 mm in thickness can be acquired. Capsular contracture occurred in six breasts (1.7%). CONCLUSIONS: During breast augmentation, an inferiorly based retromammary adipofascial flap can be created to help cover the lower pole of the breast from implant palpability. This is helpful especially in patients with thin skin, hypoplastic breasts, or constricted breasts. LEVEL OF EVIDENCE IV: 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 .

Transareolar-perinipple (areolar omega) zigzag incision for augmentation mammaplasty.

BACKGROUND: Optimal augmentation mammaplasty results not only from proper implant size and breast shape, but also from the minimization of postoperative scarring, especially in patients prone to hypertrophic scars. In this context, the authors present a transareolar-perinipple (areolar omega) zigzag approach. METHODS: Between March of 2003 and June of 2012, a total of 613 patients underwent augmentation mammaplasty using a transareolar-perinipple incision. Among them, 45 patients received a classic (straight line) transareolar-perinipple incision, whereas 568 patients received a modified zigzag transareolar-perinipple incision. RESULTS: Patients' ages ranged from 21 to 60 years. Areola size varied from 2.3 to 4.5 cm in diameter. Follow-up duration ranged from 1 to 10 years, with an average of 2 years 7 months. Postoperative complications included capsular contracture, which occurred in 16 patients (2.6 percent). Nine patients (1.5 percent) had Baker class II and seven patients (1.1 percent) had Baker class III capsular contracture. Mild inferior displacement of the implant occurred in four patients (0.6 percent). The prevalence of areolar distortion was 3.4 percent. Nipple hypesthesia was found in approximately 70 percent of the patients, which returned to normal after 2 to 3 months. Based on third-party observers, 74.7 percent of patients who received zigzag transareolar-perinipple incision had excellent to good scarring results. CONCLUSIONS: The transareolar-perinipple (areolar omega) zigzag incision resulted in satisfactory postoperative scarring and surgical results in Asian patients. This method increases the opening of the areolar incision and can be performed in patients with small (<3.5 cm) areolas. This approach can be an alternative in patients who are prone to hypertrophic scarring. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.