How to perform breast augmentation using a composite myofascial flap

Abstract

Breast augmentation is one of the most frequently performed by specialist plastic surgeons in Australia.^1^ Refinements in operative breast augmentation techniques have continued to evolve over time. Implant migration remains a concern, especially when using smooth implants. The breast implant can either displace laterally towards the mid-axillary line or inferiorly through the inframammary fold, resulting in a loss of cleavage, upper pole fullness, ‘bottoming out’ and in some cases a mega pocket. Specifically, this technique aims to prevent telemastia, defined as an abnormally wide separation between the breasts.^2^ We propose an intraoperative technique unique to primary breast augmentation that ensures the breast implant is secured by means of a composite autologous myofascial (CMF) sling involving the pectoralis major muscle. This aims to prevent inferno-lateral displacement of the breast implant which renders a poor aesthetic result secondary to loss of ‘cleavage’ and the resultant formation of a ‘mega pocket’. The authors have integrated this technique into their practice since August 2020, with case numbers now in excess of 500. The authors use the technique to mitigate implant displacement in both breast augmentation and augmentation mastopexy cases.