Bagcilar, Istanbul, Turkey From Bagcilar Research and Training Hospital.
Plast Reconstr Surg. 2013 May;131(5):1149-1156. doi: 10.1097/PRS.0b013e3182865d68.
The transaxillary route is a popular method of breast augmentation because it is associated with inconspicuous scars. The subfascial plane carries the advantages and decreases the disadvantages of subglandular and submuscular planes. In the technique described, the authors placed the implant totally subfascially to strengthen the advantages of the traditional subfascial plane.
Twenty-seven patients (50 breasts) were included in the study from 2009 to 2012. The mean patient age was 27.3 years (range, 19 to 32 years). An axillary incision was performed and the pectoralis major fascia was opened initially. With endoscopic assistance, the dissection continued craniocaudally underneath the fasciae of the pectoralis, serratus, and rectus abdominis muscles. Patients were followed up in terms of rippling, implant visibility, capsular contracture, and asymmetry.
Patients were followed up for an average of 21 months (range, 7 to 28 months). Anatomical, textured, and cohesive gel implants were used, with a mean implant size of 235 cc (range, 180 to 300 cc). In terms of the Baker classification, only 16 percent of the patients had grade II capsular contractures. There were no cases of malpositions, wrinkling, or rippling. Overall satisfaction was quite high (96 percent), and none of the patients required an implant removal or change.
A modification of the subfascial plane was demonstrated where the implants have been placed totally subfascially, in contrast to the traditional subfacial techniques. Satisfactory results have been obtained in terms of breast shape, nipple sensitivity, capsular contracture, and implant visibility. However, more long-term results are needed to evaluate the exact effect of total fascial coverage.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
经腋窝入路是一种广受欢迎的隆乳方法，因为它的切口隐蔽。筋膜下平面具有亚腺体和肌肉下平面的优点，同时减少了它们的缺点。在本文描述的技术中，作者将假体完全置于筋膜下，以强化传统筋膜下平面的优势。
2009 年至 2012 年，我们对 27 例（50 侧乳房）患者进行了研究。患者的平均年龄为 27.3 岁（19 岁至 32 岁）。在腋窝处做一个切口，首先切开胸大肌筋膜。在内镜辅助下，在胸肌、前锯肌和腹直肌筋膜下向头侧和尾侧进行解剖。随访时评估乳房的外观、包膜挛缩、假体移位、不对称等情况。
患者平均随访 21 个月（7 个月至 28 个月）。使用了解剖型、毛面和黏附型凝胶假体，平均假体大小为 235 cc（180 cc 至 300 cc）。根据 Baker 分级，只有 16%的患者有 II 级包膜挛缩。没有假体移位、皱褶或隆凸的情况。总体满意度相当高（96%），没有患者需要取出或更换假体。
我们对筋膜下平面进行了改良，将假体完全置于筋膜下，与传统的筋膜下技术不同。在乳房形态、乳头敏感度、包膜挛缩和假体可见度方面均获得了满意的效果。然而，需要更多的长期结果来评估完全筋膜覆盖的确切效果。
临床问题/证据水平：治疗性，IV 级。
