Multiplanar (4-Dimension) Breast Augmentation—A Personal Surgical Concept for Dynamic Implant-Tissue Interaction Providing Sustainable Shape Stability

Abstract

In esthetic breast augmentation long-term shape stability and natural appearance remain an ongoing challenge. The authors found that to reduce the incidence of secondary deformity and increase the natural feel and appearance, a standard multiplanar procedure combining a subfascial and dual plane approach with fasciotomies will provide long-term stability and esthetic quality. The technique involves a submuscular dissection, release of the infranipple portion of the pectoralis muscle combined with the wide subfascial release of the breast gland, and scoring of the deep plane of the superficial glandular fascia. For long-term stability, a firm fixation of the glandular fascia at the inframammary fold to the deep layer of the abdomino-pectoral fascia is critical. Long-term results were analyzed for up to 10 years. Postoperative measurements proved the intrinsic balance of the breasts without significant changes over time. The overall complication rate was <5%. Shape stability was observed over 10 years in more than 95% of the patients. Unsightly muscular animation could be avoided in almost every patient. Our results indicate that a technique of multiplane breast augmentation provides long-term stability and esthetic quality. By combining the benefits of well-established techniques of a submuscular dual plane, additional shaping through a controlled deep fasciotomy and stable inframammary fold fixation some of the existing tradeoffs of the different methods can be avoided.