Breast Augmentation Introduction

lowered incidence of clinically apparent capsular contracture

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lowered incidence of clinically apparent capsular contracture

  1. Vazquez (Aesth Plast Surg 1987) - 9.4% with the submuscular approach and 58.0% with subglandular contracture.

  2. Biggs (PRS 1990) – 12%(SM) vs 32%(SG)

  3. Puckett ((Aesth Plast Surg 1987) – 14%(SM) vs 48%(SG)

  • reduced exposure of the implant to ductal secretions and possible contamination

  • less vascular plane of dissection

  • maximal preservation of nipple sensation

  • maximises implant concealment

    1. improved contour in thin patients as edges of implant blunted

    2. enhanced transition from the clavicle to the nipple with the muscle concealing the superior aspect of the implant

  • makes mammography interpretation easier

    • Disadvantages

      • superior and lateral implant displacement

        1. prevent by cutting the muscle at its lower costal and sternal origin to relieve the pressure on the implant

      • distortion of breast shape with pectoralis contraction

      • widening the space between breasts

      • less control of upper medial fullness

      • more postoperative tenderness and more prolonged recovery

      • less precise control of inframammary fold position, depth, and configuration

        1. better to sit patient up to adjust fold during procedure

      • longer time required for deepening of the inframammary fold

    Dual plane (Tebbetts PRS 2001)

    • Dual plane = combination of retromammary and partial retropectoral)

    • Attempt to avoid a double bubble effect – gravity pulling down breast and implant being help up by pectoralis

    • Advantages:

      • glandular ptotic breast with thin soft tissues in the superior pole of the breast, a partial retropectoral or total submuscular pocket location provides the necessary additional soft-tissue coverage superiorly but risks a double-bubble deformity resulting from parenchyma sliding inferiorly off the pectoralis and implant.

      • A constricted lower pole breast in a thin patient needs additional coverage superiorly, but muscle coverage inferiorly restricts optimal expansion of the constricted lower pole.

    • Technique

      • selectively dividing the inferior origins of the pectoralis along the inframammary fold only, with no muscle division along the sternum

      • freeing the attachments of parenchyma to muscle at the parenchyma-muscle interface by dissecting in the retromammary plane between the parenchyma and the pectoralis.

    Implant Selection

    • According to Scales the ideal implant should be

    1. impervious to tissue fluid

    2. chemically inert

    3. non toxic

    4. non irritating/non inflammatory

    5. non carcinogenic

    6. non allergenic

    7. resistant to mechanical strain

    8. capable of being fabricated to a desired form

    9. sterilisable

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