Department of Plastic and Reconstructive Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Republic of Korea.
Department of Plastic and Reconstructive Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2022 Aug;75(8):2609-2615. doi: 10.1016/j.bjps.2022.02.046. Epub 2022 Mar 2.
Inferior implant malposition after breast augmentation is the second most common reason for revision surgery. This article introduces the new concept of dual-plane pocket formation in transaxillary breast augmentation to prevent inferior implant malposition by preserving the continuity of the superficial layer of the deep pectoralis fascia.
Patients who underwent transaxillary endoscopic breast augmentation performed from January 2017 to December 2019 were retrospectively reviewed. With the aid of the endoscope, dissection proceeded. During pectoralis muscle origin detachment, the superficial layer of deep pectoralis fascia was preserved. After making the pocket, silicone gel implants were inserted. A retrospective chart review was done to collect data on postoperative complications.
A total of 251 patients were performed, and the mean follow-up time was 20.6 months. In a total of 28 cases of complications (9.6%), there were 2 cases of reoperations. In a total of three patients (1.2%) of implant malposition, one patient (0.4%) developed mild bilateral bottoming-out deformity.
Meticulous dissection by endoscopy could avoid the destruction of the superficial layer of the deep pectoralis fascia during pocket dissection and produce an intact fascial system with its own continuity at the inframammary fold (IMF). A well-controlled envelope over the implant and a supporting structure underneath it are important in breast augmentation to prevent inferior implant malposition.
隆乳术后假体位置不佳是再次手术的第二大常见原因。本文介绍了经腋窝内镜隆乳术中双平面袋形成的新概念，通过保留胸大肌深筋膜浅层的连续性来防止假体位置下移。
回顾性分析了 2017 年 1 月至 2019 年 12 月期间接受经腋窝内镜隆乳术的患者。在内镜辅助下进行解剖。在分离胸大肌起点时，保留胸大肌深筋膜浅层。制作口袋后，插入硅胶凝胶假体。通过回顾性图表分析收集术后并发症的数据。
共 251 例患者，平均随访时间为 20.6 个月。共发生 28 例并发症（9.6%），其中 2 例需要再次手术。共发生 3 例（1.2%）假体位置不良，其中 1 例（0.4%）出现双侧轻度底部凹陷畸形。
通过内镜精细解剖可以避免在口袋解剖过程中破坏胸大肌深筋膜浅层，在乳房下皱襞（IMF）处产生具有自身连续性的完整筋膜系统。在隆乳术中，对假体的良好控制包膜和下方的支撑结构对于防止假体位置下移非常重要。
