Augmentation Mastopexy with Inferior Muscle Pocket and Polyurethane Prothesis
The pectoral sling muscle has been described as alternative to maintain the upper pole fullness in autologous augmentation mastopexy and breast reduction, trough securing dermoglandular flap held superiorly by pectoralis sling.
Based in this concept, the augmentation mastopexy in our institution are performed with this sling muscle supporting the prothesis, maintaining the upper pole fullness.
This article aim to describe the surgical technique and evaluate the results of augmentation mastopexies performed with inferior sling muscle
Methods/Technique: Retrospective analysis of the medical records of patients submitted to augmentation mastopexy with implants between 2017 and 2022 at the Dr Jeronimo Clinic, Ibitinga -SP, Brazil.
The variables analyzed were age, BMI, procedure length, the volume of implants, complications.
All the procedures were performed with general anesthesia. The patients were discharge in the same day or in the first post operative period.
The implants used were round, high-profile silicone implants with polyurethane texture from Silimed and Polytech.
Data were collected in Excel and analyzed descriptively.
Surgical technique
The Marking - With the patient in an orthostatic position, the thorax’s midline, the breast meridian and the inframammary groove are defined. The upper edge of the areolas is marked exactly as described by Pitanguy, projection of the inframammary groove in the breast meridian, point A. Then points B and C are determined by digital clamping maneuver, and point D is located in the previously marked breast groove, as described by Peixoto
Surgery - With the patient positioned in the dorsal position and a slight elevation of the back (30 degrees), the areolar incision is made with the Schwartzman maneuver, crossing the region from point A to points B and C. It is made keel resection of glandular or fat content, and the volume resected depending on breast size and preoperative planning. This resection goes until the pectoralis major muscle’s fascia, and it preserves the lateral and medial pillars using the electric scalpel. Then we performed a suprafascial dissection to create the implant superior poket. The lower pocket is performed through an incision in the pectoralis major muscle, in the sense of its fibers, 3 cm from its inferior insertion, towards the sternal and axillary region.
Cutaneous excess is assessed using tailor technique using. With these maneuvers, a greater ascension of the nipple-areola complex (NAC) is achieved. In an attempt to prevent longer vertical scar, lateral and medial compensations are performed, ending with an inverted T scar. The nipple-areola complex is repositioned, and it must be located at the apex of the mammary cone and with an approximate distance of 6cm from the new mammary fold.
Results/Complications: A total of 378 patients were submitted augmentation mastopexy with the technique described.
The procedure average time was 150 minutes. The patients had a mean age of 43 years, ranging from 19 to 68 years. BMI ranged from 16-38Kg/m2, with an average value of 23Kg/m2. The average time of the procedure was 150 minutes. The volume of the implants ranged from 125 to 625ml, with a mean value of 265ml.
We had a total of 34 (8.9%) complications, 13 (3.4%) unaesthetic scar ,7 (1.8%) seroma, , 5 (1.3%)asymmetries, 4 (1.1%) wound dehiscence, 3 (0.8%) partial necrosis of areola and 2 (0.5%) total areolar necrosis.
All the seromas were sent to chemical analysis, and we do not identify BIA-ALCL. We not encountered clinical signal of capsular contracture.
Conclusion: The surgical technique presented in this article, associated with the use of macrotexturized prothesis offers a reliable and safety alternative to maintain the upper pole fullness in augmentation mastopexy.