From the Plastic Surgery Division, Hospital Sírio-Libanês.
Breast Surgery Group, Plastic Surgery Division, University of São Paulo School of Medicine.
Plast Reconstr Surg. 2023 Jul 1;152(1):29e-41e. doi: 10.1097/PRS.0000000000010196. Epub 2023 Jun 29.
Augmentation mastopexy (AM) is a challenging procedure. Complications include implant displacement and visibility, which can be addressed, but the stability of the smooth implant surface and poor soft-tissue coverage may present limitations. This article describes a surgical technique for AM using a composite reverse inferior muscle sling associated with autogenous fat grafting.
Forty-five patients (90 breasts; mean age, 37.7 ± 7.2 years) underwent hybrid composite reverse inferior muscular sling AM. An upper/medial pole area between the implant and the clavicle region and parasternal area was marked to receive fat grafting and divided into three zones. Three-dimensional imaging was used to evaluate lower pole stretch and intermammary distance.
The average implant volume was 265 cc (range, 175 to 335 cc). The average fat volumes in zones I/II and III were 80.1 (range, 61.6 to 95.2 cc) and 39.3 (range, 25.2 to 47.3 cc), respectively. Five complications were observed in three patients (6.6%)-minor dehiscence in two (4.4%) and nipple-areola asymmetry in one (2.2%). The lower pole stretched 11.51% (9.9 mm) and 9.8% (8.5 mm) on the right and left sides, respectively ( P < 0.0001), between 10 days and 1 year postoperatively. The intermammary distance was reduced, on average, 49.9% (25.1 mm) ( P < 0.001) between the preoperative value and 1 year postoperatively.
Hybrid composite reverse inferior muscular sling has led to improved aesthetic results for patients with breast ptosis and poor tissue coverage. Fat grafting and recognizing cleavage zones are still important to obtain satisfactory results. This procedure offers a good alternative for AM candidates, providing an adequate smooth surface for implant stabilization.
隆乳术是一项具有挑战性的手术。并发症包括假体移位和可见度，这些问题可以通过手术解决，但假体光滑表面的稳定性和软组织覆盖不足可能会带来一些限制。本文介绍了一种使用复合下反转肌吊带联合自体脂肪移植的隆乳术。
45 例（90 侧乳房；平均年龄 37.7±7.2 岁）接受了复合下反转肌吊带隆乳术。在假体和锁骨区域之间的上内侧极点区域和胸骨旁区域标记接受脂肪移植的部位，并将其分为三个区域。使用三维成像来评估下极伸展和乳距。
平均假体体积为 265cc（范围，175 至 335cc）。区域 I/II 和 III 的平均脂肪体积分别为 80.1cc（范围，61.6 至 95.2cc）和 39.3cc（范围，25.2 至 47.3cc）。3 例患者（6.6%）出现 5 种并发症-2 例（4.4%）为轻微切口裂开，1 例（2.2%）为乳头乳晕不对称。术后 10 天至 1 年，右侧和左侧下极分别伸展 11.51%（9.9mm）和 9.8%（8.5mm）（P<0.0001）。术前和术后 1 年，乳距平均减少 49.9%（25.1mm）（P<0.001）。
复合下反转肌吊带为乳房下垂和组织覆盖不足的患者带来了更好的美学效果。脂肪移植和识别乳沟区仍然是获得满意效果的重要因素。对于隆乳术候选者来说，该手术提供了一种很好的替代方法，为假体的稳定提供了一个良好的光滑表面。
