The inframammary approach to breast augmentation

The inframammary approach to breast augmentation

References

Breast augmentation

IMF incision

Thank you.

Conclusion

• Inframammary 70.8 %(n = 438)

Transaxillary 19.7 % (n = 122)

Periareolar 9.5 % (n = 59)

• The selection of the incision should include consideration of those issues in addition to the location of the scar

Stutmanㅅ(Aesthetic Plast Surg. 2012)

• Inframammary 87.1% (n=7526)

Periareolar 11.4% (n=981)

Axillary 1.5% (n=132)

James D. Namnoum (JPRAS 2013)

• IMF approach offers the greateast visualization and results in the least damage to normal tissue.

• most common preferred incision
• the incision must be positioned well in new inframammary crease

; challengeable

Here,,,

• present surgical technique of the inframmammary approach

4 common incisions

Cases

Case 1

Preop. evaluation (VECTRA)

동영상

Case 2

Preop. evaluation (VECTRA)

동영상

Speaker: Choi YJ

대경지회 심포지움

Contents

Preoperative planning -Tissue analysis

1. Optimal soft-tissue coverage/pocket location

2. Implant volume (weight)

3. Implant type, size, and dimensions

4. Optimal location for the inframammary fold

5. Incision location

New IMF

• Based on the width of the implant selected for augmentation.
• Randquist formula

; calculated N-IMF with tissue

placed on maximum stretch

Randquist formula

If the patient has a tight or firm envelope that does not stretch, 0.5 cm should be added. If the patient has loose or overstretched skin, 0.5 cm should be substracted.

• Preoperative planning

- placement of the incision

• Surgical technique
• Considerations
• Indication
• Complication
• Conclusion

Surgical technique

Indication

Considerations

Incision

• proposed IMF, 5cm length

(saline < silicone round < shaped cohesive gel)

• begins 1 cm medial to the paramedian line and extends laterally for the appropriate distance

Dissection-

dual plane

Patient preference!

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• straight down to the muscle fascia; slightly cephalad dissection

-> avoid overlowering the IMF

• subpectoral space entrance by dividing the inferior margin of the pectoralis major muscle (1 cm superior to the fold) and stop dividing where the IMF joins the sternum
• subglandular pocket; dual plane II, III

1. Scar; hidden in the crease

2. Reoperation

; IMF < periareolar (x2.5) < axilla (x5.5)

Ref) the Inamed (now Allergan)

Corporation’s 3-year pre-market

approval data

3. Capsular contracture

; minimum contact with breast

tissue and the organizm

4. Combined surgery

; accessory breasts, nipple surgery

Dual plane type

I

II

III

5. Use of incision for revisional surgery

6. Ability to perform dual-plane pockets

7. Pain, swelling and recovery

8. Effective for widest variety of implant

9. Preservation of tissue coverage

10. Reduce trauma to implant

Implant placement

Closure

• Irrigation; Adam's solution (50 mL of povidone-iodine, 1 g of cefazolin sodium, 50,000 units of bacitracin mixed in 500 mL of normal saline)
• Insertion of implant; bimanual technique or Keller funnel assistance

• incorporating deep fascial structures into the Scarpa fascia closure to secure the fold position (preoperatively designed IMF)

PRS 2014 CME Breast augmentation

Complications

• Capsular contracture
• Double bubble deformity
• Mondor syndrome
• Implant rupture
• Breast swelling
• Displaced implant
• Extrusion
• Rippling

Cases