Experience on subfascial mammary augmentation and influence of incisions on technique

Abstract

Introduction: Mammary augmentation is among the most popular types of cosmetic procedures and mammary prosthesis the most commonly accepted technique. A mammary prosthesis can be placed on transaxillary, periareolar, submammary incisions in subglandular, subpectoral, subfascial planes or in a combination of planes. Given the potential interaction between the prosthesis and the surrounding tissues, the plane in which the prosthesis is implanted has an important role among the factors affecting this interaction. The plastic surgeon decides on the incision and plane to be used by assessing the advantages and disadvantages. Materials and Methods: Prostheses were implanted in the subfascial plane in 47 patients who underwent augmentation mammaplasty. Round Moderate Plus or High Profile Cohesive II™ Gel implants were used. Device volumes ranged from 275 to 600 cc. Of the 47 procedures, 23 were performed over an axillary incision, 20 over an inframammary incision, and 4 over a periareolar incision. Endoscopic-assisted dissection was performed in all of the 23 cases in which transaxillary incision was used. Results: All 47 patients who underwent subfascial prosthesis implantation were followed up for a mean of 5 years (range: 2–7 years). Long-term results were satisfactory with few complications. The overall patient satisfaction rate was 89.3%, and none of the patients required an implant removal or change. None of the patients complained of severe pain, regardless of the type of incision, and resumed their daily activities on postoperative day 2. Conclusion: The subfascial augmentation technique provides good and long-term results. It requires longer operating times and is a more difficult technique compared to other planes. As the choice of incision does not largely affect the overall result, the position of the scar depends on the patient's preference, the properties of the implant, and the experience of the surgeon. The endoscopic assistance should be preferred when using the transaxillary approach.