Salgarello Marzia, Visconti Giuseppe
Department of Plastic and Reconstructive Surgery, Università Cattolica del "Sacro Cuore" - University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy.
, Via Massimi 101, 00136, Rome, Italy.
Aesthetic Plast Surg. 2017 Oct;41(5):999-1006. doi: 10.1007/s00266-017-0918-8. Epub 2017 Jun 27.
Double-bubble and bottoming-out deformities represent the second most common reason for revision surgery in breast augmentation. Etiopathogenesis of these complications is still unclear. The aim of this paper is to report our findings in breast cadaver dissections focusing on the inframammary fold (IMF) applied anatomy and to critically review our ten-year experience in breast augmentation.
A cadaveric study has been performed on four consecutive embalmed cadavers. A retrospective review of 207 consecutive women who underwent breast augmentation, using the submuscular dual-plane technique with a periareolar approach, between January 2003 and January 2013, was performed.
According to our dissections, the IMF is a complex osseo-fascio-cutaneous structure in which the superficial pectoralis fascia represents a key structure in breast augmentation surgery. Hence, a critical analysis of the IMF relationship with surrounding breast structures helps to understand the etiology of double-bubble and bottoming-out deformities and gives the anatomical basis to prevent them. In our early clinical experience, we experienced 3% of double-bubble and 6% of bottoming-out deformities. Those complications were avoided later by dissection in the inferior pole according to the anatomical findings.
Bottoming-out and double-bubble deformities can be avoided if an anatomical approach is used during pocket dissection at the level of the IMF, paying attention to avoid disrupting the superficial and deep attachments of the superficial pectoralis fascia at the IMF. A comprehensive understanding of IMF anatomy and the key surgical maneuvers to avoid these complications must be taken into account for each route of dissection.
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双泡畸形和乳房下极下垂畸形是隆胸修复手术的第二大常见原因。这些并发症的病因仍不清楚。本文旨在报告我们在乳房尸体解剖中的发现，重点关注乳房下皱襞（IMF）的应用解剖，并批判性地回顾我们十年的隆胸经验。
对连续四具防腐尸体进行了尸体研究。对2003年1月至2013年1月期间连续207例行隆胸手术的女性进行了回顾性研究，这些女性采用乳晕周围入路的胸肌下双平面技术。
根据我们的解剖，IMF是一个复杂的骨-筋膜-皮肤结构，其中胸大肌浅筋膜是隆胸手术中的关键结构。因此，对IMF与周围乳房结构关系的批判性分析有助于理解双泡畸形和乳房下极下垂畸形的病因，并为预防这些畸形提供解剖学依据。在我们早期的临床经验中，我们经历了3%的双泡畸形和6%的乳房下极下垂畸形。后来根据解剖结果在下极进行解剖，避免了这些并发症。
如果在IMF水平进行腔隙剥离时采用解剖学方法，注意避免破坏胸大肌浅筋膜在IMF处的浅、深附着，就可以避免乳房下极下垂和双泡畸形。对于每条剥离路径，都必须全面了解IMF解剖结构以及避免这些并发症的关键手术操作。
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