• Archives of Plastic Surgery
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• 제33권2호
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• pp.155-160
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• 2006

Although several reports have been introduced about dual plane augmentation mammaplasty, the description of periareolar approach dual plane augmentation mammaplasty was few. This article describes specific characteristics, and different classification and techniques for the periareolar dual plane breast augmentation while postoperative scars resulted from inframammary crease approach caused complaints. A total of 124 patients(248 breasts) had periareolar dual plane augmentation surgery from 1998 to 2004. Anatomic implants were used in 43 cases. Most of the patients were satisfied with the outcomes of periareolar dual plane augmentation. Periareolar dual plane augmentation mammaplasty adjusts implant and tissue relationships to ensure adequate soft-tissue coverage while optimizing implant-breast parenchymal dynamics to offer increased benefits and fewer faults compared to a single pocket location in a wide range of breast types with minimal scars. Two types of dual plane classifications are discussed in this study for the periareolar approach exclusively. The boundaries of retroglandular dissection remain constant, as the costal origin of pectoralis major are divided. Type A dual plane implies that the inferior edge of pectoralis muscle lies below the inferior areolar border, and type B dual plane implies that the inferior edge lies above the superior areolar border.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.99-104
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• 2007

Purpose: Subfascial augmentation mammaplasty was introduced by Dr. Graf in 2000. Subfascial placement of breast implants for augmentation was advocated as an option that has some of the advantages of both the subpectoral and subglandular placement while minimizing the disadvantages of each. The clinical experiences of 23 breast augmentations in the subfascial placement are reported. The indications for this technique are proposed. The incidence of complications is described from clinical experiences and compared with that of other methods. Methods: From January of 2004 through December of 2005, 23 patients underwent periareolar subfascial augmentation mammaplasty. The mean postoperative follow-up time was 8 months. Results: In comparing the results of the subpectoral augmentation group(57 patients) with those of the dual plane(124 patients) and subfascial groups(23 patients), the total rate of complications didn't represented the significant difference. The benefits of this technique include avoiding hematoma(as seen in the dual plane) and muscle action(in the subpectoral), and minimizing postoperative chest pain(inherent to subpectoral), and the ability to correct ptosis. And also this subfascial technique can be used for changing the plane from submuscular to subfascial in case of the reoperations. Conclusion: We're thinking that the periareolar subfascial augmentation mammaplasty would be the very useful tool for the primary and secondary breast augmentations.

• Archives of Plastic Surgery
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• 제35권5호
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• pp.545-552
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• 2008

Purpose: The transaxillary approach for breast augmentation has been advocated for patients and surgeons for several decades. However, this blind technique had many disadvantages including, traumatic dissection, difficult hemostasis, displacement of implants, and ill-defined asymmetrical location of inframammary crease. In the present study, the precise endoscopic electrocautery dissection was applied to eliminate the limits of blunt dissection throughout the procedures. Methods: From December 2006 to December 2007, a total of 103 patients with an average age of 29.5 years underwent endoscopic assisted transaxillary dual plane augmentation mammoplasty. The mean implant size was 243 cc with the range between 150 and 350 cc. Through a 4 cm axillary incision, electrocautery dissection for submuscular pockets was carried out under the endoscopic control. The costal origin of pectoralis muscle was completely divided to expose subcutaneous tissue and to make type I dual plane. Results: Using the endoscopic dissection, we achieved good aesthetic results including a short recovery period, less morbidity, and symmetrical well-defined inframammary crease. Type I dual plane procedure could support the consistent inframammary fold shape and be applied to most patients without breast ptosis. Minor complications did not occur, however, four major complications of capsular contracture occurred. Conclusion: In contrast to the era of the blind techniques, endoscopic assisted transaxillary dual plane breast augmentation can now be performed effectively and reproducibly. With Its advantage, the axillary application of endoscopy for augmentation mammaplasty is useful to achieve the optimal cosmetic outcomes.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.105-110
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• 2007

Purpose: The major drawback of submuscular augmentation of the ptotic breast is a "double-bubble" deformity. If a traditional mastopexy is added to correct the ptosis, there would be additional scars. This article describes simultaneous periareolar mastopexy with dual plane or subfascial breast augmentations. Methods: A series of 81 patients with grade I or II ptosis underwent the procedure from 1999 to 2005. Out of these, dual plane augmentation was done in 71 cases and subfascial plane in 10. After periareolar skin excision, an incision is made perpendicularly down to the fascia of pectoralis. At the lower pole, all breast implants are inserted into the subfascial plane. In case of upper pole thickness of above 20 mm, we inserted the implant into the subfascial plane, whereas below 20 mm, we inserted that into the submuscular plane. Results: No major complications were noted and patients' satisfactory score was high. This technique avoids the "double-bubble" deformity and leaves a minimal periareolar scar. Conclusion: Simultaneous periareolar mastopexy/breast augmentation is useful for correction of the ptotic breast, increasing the volume of breast and providing the natural breast shape with minimal scars. We consider that subfascial plane augmentation with periareolar mastopexy to be an alternative for cases with breast upper pole thickness of at least above 20 mm.

• Archives of Plastic Surgery
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• 제35권1호
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• pp.78-85
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• 2008

Purpose: The capsular contracture has been the most common complication of augmentation with breast implant, a side effect quite difficult to treat. The latest trends in the correction of capsular contracture include total capsulectomy or conversion of implant pocket. In this study, in an attempt to correct capsular contracture, the authors performed reoperation which involved capsulectomy through peri-areolar approach and dual-plane conversion. The authors hereby report the clinical results of such correction of capsular contracture and examine the efficacy. Methods: The authors selected 46 patients who were admitted to the clinic from January 2004 to January 2007 (37 months), and performed dual-plane conversion through solely peri-areolar approach. Two types of operation were done: dual-plane conversion from subglandular plane or from submuscular plane. Results: The average follow-up time after conversion to the dual-plane position was 10 months. During the follow-up period, 83.1% of patients recovered from capsular contracture and were Baker class I, and in 10.9% the condition had relapsed into Baker class II or III contracture. Conclusion: This study has proven the effectiveness of the dual-plane conversion operation for correcting established capsular contracture after previous augmentation mammaplasty. In this study, all cases of dual-plane conversion operation was performed through peri-areolar approach, which can prevent the occurrence of visible scar on inframammary fold.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.29-32
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• 2009

Purpose: Introduction of the mammary implant through the abdominal route has been well known since late 1960s, but the use of transabdominal route for contralateral breast augmentation in transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction patients has not been reported in Korean literature. The authors report their experience with technical points as well as the selection of the appropriate patients. Methods: Simultaneous contralateral augmentation mammaplasty through transabdominal route was performed in 11 patients who underwent TRAM breast reconstruction from August 2003 to May 2008 with a mean follow up of 27 months. The pocket was created under direct vision: 3 subglandular, 7 subpectoral, and 1 dual plane was dissected. Eight saline and 3 silicone gel implants were used with an average volume of 165 cc. Results: There were no complications such as infection, hematoma, implant displacement, and capsular contracture. The result was well maintained throughout the follow up period. Conclusion: Transabdominal route could be recommended in selected patients for contralateral augmentation in TRAM breast reconstruction.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.407-413
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• 2014

Background Implant malposition can produce unsatisfactory aesthetic results after breast augmentation. The goal of this article is to identify aspects of the preoperative surgical planning and intraoperative flap fixation that can prevent implant malposition. Methods This study examined 36 patients who underwent primary dual plane breast augmentation through an inframammary incision between September 1, 2012 and January 31, 2013. Before the surgery, preoperative evaluation and design using the Randquist formula were performed. Each patient was evaluated retrospectively for nipple position relative to the breast implant and breast contour, using standardized preoperative and postoperative photographs. The average follow-up period was 10 months. Results Seven of 72 breasts were identified as having implant malposition. These malpositions were divided into two groups. In relation to the new breast mound, six breasts had an inferiorly positioned and one breast had a superiorly positioned nipple-areolar complex. Two of these seven breasts were accompanied with an unsatisfactory breast contour. Conclusions We identified two main causes of implant malposition after inframammary augmentation mammaplasty. One cause was an incorrect preoperatively designed nipple to inframammary fold (N-IMF) distance. The breast skin and parenchyma quality, such as an extremely tight envelope, should be considered. If an extremely tight envelope is found, the preoperatively designed new N-IMF distance should be increased. The other main cause of malposition is failure of the fascial suture from Scarpa's fascia to the perichondrium through an inframammary incision. As well, when this fixation is performed, it should be performed directly downward to the perichondrium, rather than slanted in a cranial or caudal direction.

• Archives of Plastic Surgery
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• 제46권1호
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• pp.7-15
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• 2019

Breast animation deformity (BAD) has been reported to occur after submuscular implant placement following breast augmentation and immediate breast reconstruction. Despite its apparent impact on patients' quality of life, BAD has only recently become a topic of general concern. Its incidence and etiology have yet to be established. The aim of this systematic review was to identify papers that clearly defined and classified BAD and described how the degree of animation was assessed. We performed a search in PubMed and Embase. Studies meeting the inclusion criteria that described BAD after implant-based breast augmentation or immediate breast reconstruction were included. After screening 866 publications, four studies were included: three describing BAD after breast augmentation and one describing BAD after immediate breast reconstruction. The median percentage of patients with some degree of BAD was 58%. The highest percentages were found in patients operated on using the Regnault technique or the dual-plane technique (73%-78%). The lowest percentages were found following the dual-plane muscle-splitting technique (30%) and the triple-plane technique (33%). We found no studies meeting the inclusion criteria that analyzed BAD after prepectoral implant placement. This review of the current literature suggests that the degree of BAD is proportional to the degree of muscle involvement. Evidence is scarce, and the phenomenon seems to be underreported. Future comparative studies are warranted.