Capsulomusculofascial Flap: A Treatment Option for Aesthetically Unacceptable Subglandular Saline Augmented Breasts

Abstract

Textured or smooth saline implants placed in a subglandular position may provide an aesthetically acceptable result initially. However, over time, the breast may assume a superior fullness with visible ridges at the periphery of the implant, and an unacceptable “rippling” becomes evident and palpable. Procedures to replace the implant in a submuscular pocket will frequently improve the situation. However, in many instances there remains insufficient soft tissue coverage or support of the implant in its new site. In this study 23 patients underwent implant exchange. I obtained adequate soft tissue coverage with a technique not previously described, which consists of mobilization of a flap from the posterior aspect of the implant capsule. This is combined with serratus muscle and when necessary, rectus fascia and muscle, to provide adequate soft tissue coverage and inferior support while reconstituting the inframammary fold at its proper level. The capsular flap has remained viable, and all patients in this series have remained free of the problems for which they initially sought consultation (longest follow-up is 4 years).