Muscle-Splitting Augmentation-Mastopexy: Implant Protection With an Inferior Dermoglandular Flap.

Simultaneous augmentation-mastopexy can achieve excellent patient and surgeon satisfaction but continues to pose a challenge, with revision rates of up to 25%. Recurrent ptosis and poor overall breast shape are 2 common reasons for reoperation, whereas some of the most feared complications is breast implant exposure, infection, and loss secondary to wound breakdown; excessively large implants or too much tension during closure are possible contributing factors. We describe a technique for augmentation-mastopexy combining a muscle-splitting pocket for implant placement along with an inferior flap, which helps secure the implant in place and provides coverage in case of wound dehiscence. A retrospective chart review was performed (January 2015 to December 2017) of women who underwent augmentation-mastopexy with round, textured silicone gel implants using a muscle-splitting technique combined with an inferior de-epithelialized dermoglandular flap. A total of 118 patients (236 breasts) were operated on. Mean follow-up was 13 months (10-42 months). Mean patient age was 33.3 years (24-55 years). Mean operative time was 102.9 minutes (80-135 minutes), and implant size ranged from 175 to 350 mL (mode, 275 mL). There were no cases of implant extrusion, nipple-areola complex ischemia, or surgical site infection; however, 1 patient required revision surgery for implant malposition, and 2 had a postoperative hematoma. In summary, the technique we describe combines 2 established mammaplasty techniques, ensuring upper pole fullness with good cleavage, implant protection in case of wound breakdown, and good patient satisfaction as evidenced by a low revision rate and minimal complications. LEVEL OF EVIDENCE: IV, therapeutic. Evidence obtained from multiple time series with or without the intervention, such as case studies.

Transaxillary muscle-splitting breast augmentation: experience with 160 cases.

BACKGROUND: Muscle-splitting breast augmentation, initially described by Baxter and later popularized by Khan, has proved to be an effective technique in terms of implant coverage, bypassing, and even solving of some issues associated with the dual-plane technique. A muscle-splitting breast augmentation technique recently has been used in combination with mastopexy. However, no reports have described muscle-splitting techniques accomplished by the transaxillary route. METHODS: A prospective study was conducted to evaluate the outcomes and complications of a novel approach to a specific breast augmentation technique. A total of 160 patients underwent bilateral transaxillary muscle-splitting breast augmentation between October 2007 and July 2010. All the patients were treated on an outpatient basis and received epidural anesthesia. Soft, round, textured, cohesive gel implants ranging in size from 200 to 350 ml were used. RESULTS: All the patients recovered quickly. To date, no infection, capsular contracture, rippling, double-bubble deformity, muscle contracture-associated deformities, or implant migration has occurred. Four patients (2.5%) experienced hematomas, all of which resolved before discharge. All the patients were discharged less than 24 h postoperatively and had an aesthetically natural result. CONCLUSION: Transaxillary muscle-splitting breast augmentation, a novel approach to a technique that has been described previously, provides consistent, satisfactory results and good reproducibility. This new approach provides an excellent anatomic final appearance with no risk of displacement, rippling, double-bubble deformity, or contracture-associated deformities. Furthermore, this technique avoids any visible scars on the breast and features a low complication rate.