Submuscular Augmentation Mammaplasty Research Articles

Evaluation, Comparison, and Analysis of Postoperative Injury between Submuscular and Retroglandular Augmentation Mammaplasty

Evaluation, Comparison, and Analysis of Postoperative Injury between Submuscular and Retroglandular Augmentation Mammaplasty

The Efficacy and Safety of DepoFoam Bupivacaine in Patients Undergoing Bilateral, Cosmetic, Submuscular Augmentation Mammaplasty: A Randomized, Double-Blind, Active-Control Study

Breast augmentation can result in significant postsurgical pain. The authors evaluate the extent and duration of analgesia achieved with extended-release DepoFoam bupivacaine (Pacira Pharmaceuticals, Inc., Parsippany, New Jersey) in patients undergoing bilateral, cosmetic, submuscular augmentation mammaplasty under general anesthesia. In this randomized, multicenter, double-blind study, patients received a single dose of DepoFoam bupivacaine 600 mg or bupivacaine HCl 200 mg divided into the implant pockets at the conclusion of surgery. The primary efficacy measure was cumulative pain score with activity through 72 hours postoperatively. Secondary efficacy measures included pain intensity with activity and at rest, postsurgical consumption of rescue opioids, and integrated rank analysis combining pain scores at rest with the amount of opioid used. One hundred thirty-six patients were randomized and treated (DepoFoam bupivacaine, n = 66; bupivacaine HCl, n = 70). Reflecting the underpowered nature of the study, the mean cumulative pain score (numeric rating scale with activity through 72 hours) was 441.5 with DepoFoam bupivacaine versus 468.2 with bupivacaine HCl (P = .3999). Total amounts of opioid consumed were significantly lower in the DepoFoam bupivacaine group through 24 hours (P = .0211) and through 48 hours (P = .0459). The prespecified integrated rank analysis showed statistically-significant differences at multiple time points up to and including 60 hours; results on most other efficacy measures trended in favor of DepoFoam bupivacaine. No serious adverse events were reported, and no patients discontinued the study due to adverse events. DepoFoam bupivacaine trended toward benefit versus bupivacaine HCl on most efficacy measures. Due to early termination, the study was underpowered to achieve statistical significance.

Gesteigertes Selbstvertrauen und vermindertes körperlich-sexuelles Missempfinden nach subpektoraler Mammaaugmentation

The study objectively discusses the causal relationship between submuscular breast augmentation mammaplasty and improved aspects of quality of life. The goal was to assess a possible increase in certain aspects after undergoing cosmetic breast enlargement surgery under consideration of 4 different aspects. Between 2005 and 2006, a total of 65 women were given a standardised patient questionnaire (body image assessment questionnaire) preoperatively as well as 6 months postoperatively after undergoing cosmetic submuscular augmentation mammaplasty: 58 of these questionnaires could be evaluated successfully. All of the patients had undergone augmentation mammaplasty for the first time. The following criteria were assessed and evaluated using a point value system (0-100 points): attractiveness/self-confidence, insecurity/anxiety, emphasis placed on physical appearance, and sexual discomfort. With regard to the questions dealing with attractiveness/self-confidence, a highly significant improvement in the patient's self-assessment of said criteria after undergoing cosmetic submuscular augmentation mammaplasty as compared to their own preoperative assessment was apparent. In addition, a significantly improved level of sexual satisfaction after the medical procedure was also demonstrated. In the same fashion, the answers to the series of questions dealing with emphasis placed on physical appearance also exhibited a positive change. The only topic that exhibited next to no change was the series of questions dealing with insecurity/anxiety. Cosmetic augmentation mammaplasty is an available therapy that can increase a patient's own self-assessment of attractiveness and self-confidence in a significant way. In addition, this operation leads to a significant increase in sexual satisfaction, and because of this and the aforementioned change of emphasis placed on physical appearance, an overall improvement in certain aspects of the quality of life can be achieved.

Dynamic Breasts: A Common Complication Following Partial Submuscular Augmentation and its Correction Using the Muscle-Splitting Biplane Technique

Dynamic breast deformity following partial submuscular augmentation is not uncommon. The complication is due primarily to the release of the pectoralis and the true incidence of this complication is not known. The submuscular biplane pocket is a new pocket and is used to correct dynamic breasts following augmentation mammaplasty in the partial submuscular plane. After the first submuscular biplane muscle-splitting augmentation mammaplasty in October 2005, the author has performed 58 secondary augmentation mammaplasties for various reasons. Of these, nine patients showed marked dynamic breast deformity following partial submuscular augmentation and the submuscular muscle-splitting biplane was used to correct this complication. Good to excellent results were achieved in all patients with complete elimination of the dynamic breast deformity. The submuscular biplane is a new and versatile pocket and is used to correct dynamic breast deformity seen following partial submuscular augmentation mammaplasty.

Pregabalin Has Opioid-Sparing Effects Following Augmentation Mammaplasty

There has been a recent, growing concern regarding narcotic use in surgical patients. This issue, coupled with an ongoing desire to lessen postoperative discomfort, has prompted the search for alternative analgesic regimens. The purpose of this study was to determine whether the addition of pregabalin, an anticonvulsant indicated for the management of neuropathic pain, to an analgesic regimen reduced narcotic use and reported pain following augmentation mammaplasty. Eighty patients underwent submuscular augmentation mammaplasty with smooth shell saline mammary prostheses in an outpatient surgical facility. The patients were randomized into two groups. Group A (n = 40) used 5-mg hydrocodone tablets as needed to manage postoperative pain. Group B (n = 40) used pregabalin, 75 mg, twice daily in addition to 5-mg hydrocodone tablets as needed for postoperative pain management. Narcotic use was recorded and pain assessed daily using the Rogers Pain Scale from 1 (mild) to 10 (severe). Patients were surveyed for nausea and quality of pain. Group A used 115 +/- 32 mg hydrocodone during the immediate 7 day postoperative period and reported an average pain scale score of 5.3. Likewise, group B used 33 +/- 27 mg hydrocodone as well as the prescribed pregabalin dosage and reported an average pain scale score of 3.4. Patients in group B reported less nausea. These differences were statistically significant (P < .05). Patient age, implant size, and postoperative complications were similar between the two groups. Perioperative pregabalin administration in patients undergoing augmentation mammaplasty reduced postoperative narcotic use by 70%. There was also significantly less reported pain and a 46% reduction in nausea in the pregabalin-treated group. Pregabalin has few side effects, no drug interactions, and should be considered safe in an analgesic regimen.

Endoscopic transaxillary subpectoral augmentation mammaplasty: A safe and predictable procedure

During the last decades breast augmentation has gained worldwide acceptance. In addition to the inframammary and periareolar approach for augmentation mammaplasty, the transaxillary route provides an elegant means of retaining the integrity of the breast mound by avoiding visible scars. Due to concerns as to the safety of this technique we analysed 47 patients who underwent endoscopy-assisted transaxillary submuscular augmentation mammaplasty in our department from 1999 to 2004. The inclusion criteria were aesthetic breast augmentation due to breast hypoplasia. Patients with a history of breast cancer, other malignancies, or previously performed mastectomy were excluded. Procedures for tuberous breast deformity as well as concomitantly performed mastopexy were also excluded. No complications were observed impairing final outcome or requiring early operative intervention, such as infection or haematoma. This technique is suitable for patients who prefer a hidden incision at a distant site, and provides predictability of aesthetic outcome and is safe.

Striae Distensae after Submuscular Augmentation Mammaplasty-A Case Report

Cutaneous striae is a common and cosmetically troublesome problem on our skin. However, it is found rarely after augmentation mammaplasty and remains clinical mystery. Up to date, there is not definite treatment and a preventive means. We present a 19-year-old nulliparous female with striae distensae (SD) after submuscular augmentation mammaplasty and try to treat the complication with intense pulse light (IPL) and get satisfactory result. Although SD after breast augmentation is unusual, we have obligation to remind patient of this rare but troublesome complication and review medication history of suspicious case before surgery. Once happened unfortunately, IPL and cessation of steroid therapy can be helpful to resolve such problem.

Celecoxib reduces narcotic use and pain following augmentation mammaplasty

Narcotics have traditionally been used to control pain after augmentation mammaplasty, but they have adverse side effects, including addiction potential, clouded sensorium, nausea, and respiratory depression. Alternative strategies for managing postoperative pain are expensive, cumbersome, and also have their own risks. While long-term use of celecoxib has been associated with an increased risk of serious adverse cardiovascular effects, no problems have been reported with short-term use. The purpose of this study was to determine whether the addition of celecoxib, a selective nonsteroidal anti-inflammatory, to an analgesic regimen reduced narcotic use and pain following augmentation mammaplasty. One hundred patients underwent submuscular augmentation mammaplasty with smooth saline-filled mammary prostheses using an intravenous sedation technique. Group A (N = 50) used hydrocodone to manage postoperative pain. Group B (N = 50) used celecoxib 400 mg 1 to 2 hours before surgery and then daily in addition to hydrocodone postoperatively. Narcotic use, incidence of nausea, and complications were recorded. Pain was assessed daily with a Likert pain scale from 0 (no pain) to 10 (severe pain). Group A used 110 +/- 34 mg hydrocodone during the immediate 7-day postoperative period and reported an average pain scale score of 5.1. Group B, which used celecoxib, used 34 +/- 22 mg hydrocodone during the same period with an average pain scale score of 3.3. These differences were statistically significant (P < .05). Group B experienced 53% less nausea than Group A. There were no significant differences between the groups regarding age, implant size, or complications. Perioperative celecoxib administration in patients undergoing augmentation mammaplasty significantly reduced postoperative narcotic use, pain, and nausea. Its use should facilitate the patient's ability to resume everyday activities following surgery.

A Technique to Decrease Breast Shape Deformity During Muscle Contraction in Submuscular Augmentation Mammaplasty

The main objective of this study was to decrease breast shape distortion during pectoralis muscle contraction following submuscular augmentation mammaplasty. We followed 348 patients who had retromuscular augmentation mammoplasty: 251 (72.1%) had polyurethane-covered gel-filled, 97 (27.9%) had textured-silicone gel-filled implants. Among the 348, 46 had surgery following the Regnault technique and 302 had surgery by the below-mentioned technique. Periareolar incision, bipartision of breast parenchyma down to the fascia, undermining of breast base from the fascia downward to the inframammary sulcus or a little below it, detaching of muscle off the thoracic cage, disinsertion of abdomino-costal pectoralis attachments. Full thickness incision of pectoralis muscle on a vertical line on the nipple projection for 2-5 inches. Placing of prosthesis. Drainage. Closure. No objective evaluation was used, only clinical judgments by three observers--the surgeon, a nurse and the patient herself. The results showed a definite decrease of the dynamic deformity among patients in whom the author's technical variation was carried out. This technique allows also, for decreasing the upward pushing of the implant during pectoralis muscle contraction and facilitates stretch of the breast tissue in patients with tighter breast envelopes. Despite lack of precise measurements, conclusions drawn from clinical judgments, taken as objectively as possible, suggest that the use of this technique may offer the solution of an otherwise disturbing collateral effect, frequently seen after this operation.

Submuscular augmentation mammaplasty using a perinipple incision.

The periareolar approach for submuscular augmentation mammaplasty sometimes shows a widened or hypertrophic scar and distorts the shape of the areolar-skin junction. The authors describe submuscular augmentation mammaplasty using a perinipple incision and muscle preservation techniques. The perinipple incision can be extended using a backcut within the areola according to the thickness of the index finger of the operator. The authors could reach the lateral edge of the pectoralis major and lift it while preserving anatomic continuity. The folded, smooth saline implant was introduced with a no-touch or minimal-touch technique. Implant volumes ranged from 175 to 325 mL. Ten to 25-mL volume was overfilled (within the recommended amount), particularly large volume was overfilled in patients who had a thin envelope to reduce the palpation of the edge of the implant. From August 2000 to December 2002, 306 patients underwent subpectoral augmentation mammaplasty via the perinipple approach. Eleven patients complained of rippling or a visible fold. There were 7 patients who required a partial capsulectomy through the perinipple incision again. The scar was well hidden but scar revision was needed in 17 patients as a result of skin slough on the areola flap. Of these cases, some were camouflaged using a medical tattooing procedure as well. Pain was reduced markedly compared with the axillary approach. In conclusion, the perinipple incision has a less visible scar in patients who have an ill-demarcated skin-areolar junction and provides a similar operative field compared with the periareolar incision. In addition, preservation of the normal skin-areola junction is cosmetically successful.

A survival plan.

Washington, D.C. From the Division of Plastic Surgery, Georgetown University Medical Center. Received for publication December 29, 2000; revised February 2, 2001. Follow-up to Spear, S. L., Matsuba, H., and Little, J. W. The medial periareolar approach to submuscular augmentation mammaplasty under local anesthesia. Plast. Reconstr. Surg. 84: 599, 1989. Scott L. Spear, M.D. Division of Plastic Surgery Georgetown University Medical Center 1st Floor PHC Building 3800 Reservoir Road, N.W. Washington, D.C. 20007[email protected]

Sequestered fluid and breast implant malposition.

A meniscus of serosanguineous fluid may persist for weeks at the inferior pole of the periprosthetic space after submuscular augmentation mammaplasty. Subsequent tissue accommodation may allow the prosthesis to become displaced into the space kept patent by the fluid meniscus. Implant malpositions of this etiology can be circumvented by the routine use of small suction drains.

Endoscopic transaxillary submuscular augmentation mammaplasty with textured saline breast implants.

The utility of the endoscope was realized in a retrospective analysis of 92 consecutive patients undergoing augmentation mammaplasty with saline-filled textured implants. The transaxillary submuscular approach was used. All patients received preoperative antibiotics and instillation of methylprednisolone into the saline fill, with inflation to manufacturer-recommended levels. complications included seven implant deflations (3.8%), eight implant malpositions (4.3%), and one capsular contracture (0.6%). Of the eight malpositions, six were corrected using the endoscopic technique without removal of the implant and with early manipulation of the implant within the pocket. We conclude that endoscopic control in augmentation mammaplasty is beneficial in secondary operative procedures and we speculate that the endoscope will lessen the rate of implant malposition observed in this study.

Transaxillary submuscular augmentation mammaplasty

At least three different implant pockets for transaxillary submuscular (TASM) augmentation mammaplasty have been reported in the literature. To verify and clarify the features of the anatomical structures involved in a TASM procedure the authors studied the anatomy of the anterior thorax in operated and unoperated breasts of ten fresh female cadavers. In particular, some fascial and muscular observations are stressed, demonstrating that TASM augmentation mammaplasty always leads to a pocket where the upper one-third of the prosthesis is covered by the pectoralis major muscle, while the inferior two-thirds lies in a subglandular/subcutaneous plane.

The Medial Periareolar Approach to Submuscular Augmentation Mammaplasty under Local Anesthesia

Spear, Scott L. M.D.; Matsuba, Howard M.D.; Little, John W. III. M.D. Author Information

The Medial Periareolar Approach to Submuscular Augmentation Mammaplasty under Local Anesthesia

The medial approach to submuscular augmentation mammaplasty under local anesthesia begins with a medial periareolar incision around one-half or more of the areola. A subcutaneous tunnel is made toward the medial breast border, avoiding mammary ducts and sensory nerves to the nipple. The breast is reflected laterally, exposing a patch of pectoralis major muscle. A submuscular pocket is then created beneath portions of the pectoralis major, rectus abdominis, external oblique abdominis, and serratus anterior muscles, after which the implant is inserted and the muscle, dermis, and skin are closed sequentially. The periareolar incision allows for favorable scars without compromising the access or exposure necessary for accurate implant placement. Complete muscle coverage of the implant should contribute to a lower rate of capsular contracture. With a medial submuscular approach, nipple sensation is rarely altered, and revisions, if necessary, can be done through the same incision, still under local anesthesia, for increased safety, economy, and convenience. The medial approach to breast augmentation is a highly versatile, safe, and consistent method of achieving excellent results in breast augmentation in terms of scar, symmetry, and softness.

Costal Cartilage Sculpturing as an Adjunct to Augmentation Mammaplasty

Costal cartilage irregularities are a major component of most congenital thoracic-wall deformities. A significant number of patients with these cartilage irregularities may either refuse major reconstruction or in fact have disorders of insufficient magnitude to justify such endeavors. In patients undergoing augmentation mammaplasty, recontouring or sculpturing of these abnormal costal cartilages may correct or improve the underlying chest-wall deformity and thus enhance the final aesthetic result. This method has had application in mild to moderate asymmetrical cases of both pectus excavatum and pectus carinatum, thoracic hypoplasia (Poland's syndrome), isolated cartilage deformities, and spinal scoliosis. In our hands, the combination of cartilage sculpturing with submuscular augmentation mammaplasty is performed as an outpatient local anesthetic procedure requiring not more than 90 minutes.