The autologous internal breast splint: A novel technique for the treatment of postaugmentation ptosis

Abstract

Many patients who receive breast implants eventually develop breast ptosis and a descent of the inframammary fold. This usually requires either exchange for a larger implant, mastopexy (vertical or "T" incision), or more recently, the use of the so-called "power lift" or suturing of the posterior leaf of the capsule to the pectoralis major muscle. We report on a new technique for correction of postaugmentation ptosis, also called "implant ptosis," (IP) without making any further incisions on the breast or producing any breast distortion. A capsulotomy was performed through existing incisions, and the implant was removed. The posterior capsule was elevated from either the pectoralis major muscle (subglandular implants) or the anterior chest wall (submuscular implants). Approximately one half of the posterior capsule was reflected from its posterior attachments and then sutured to the anterior leaflet of the capsule, creating a "sandwich." This internal autologous splint elevated and medialized the implant, while adding thickness and strength to the capsule. It was then sutured to the periosteum of the anterior rib at the level of the new inframammary fold. The new implant was then placed in the submuscular position. Operations were performed between 4 months and 8 years after the original augmentations in 11 women with bilateral breast implants who developed Grade II to III ptosis after augmentation in either the subglandular (n = 4) or submuscular (n = 7) positions. Preoperatively, all patients displayed Type 1 or 2 capsules. Follow-up was from 1 to 3 years after surgery. The technique produced an aesthetically pleasing breast with correction of the ptosis. No additional incisions on the breast were necessary, and no restrictions to breast shape were noted with full arm motion. Long-term follow-up displayed good position of the nipple-areolar complex and high patient satisfaction. The autologous internal breast splint is a novel technique for the treatment of postaugmentation ptosis that both medializes and elevates the implant when necessary. Altlhough it was performed through previous incisions in this study, it may be coupled with a standard mastopexy procedure. This technique may solve many of the problems associated with postaugmentation breast ptosis and warrants further investigation.