Submuscular Breast Augmentation Research Articles

Retrospective Study on Optimizing Breast Augmentation Outcomes in Transgender Patients: A Comprehensive Analysis of Tumescent Local Anesthesia Technique.

Tumescent local anesthesia (TLA) involves the infusion of a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While the use of TLA in sub-glandular augmentation mammoplasty has been documented, we present a modified TLA approach for primary sub-muscular breast augmentation in transgender patients based on our experience over the past years. Between the years 2014 and 2021, we performed primary sub-muscular breast augmentation on 20 transgender patients under TLA and conscious sedation. The tumescent solution consisted of 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1 mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. Initially, the solution was infiltrated between the pectoral fascia and the mammary gland, and subsequently, during the surgery, under the pectoralis major muscle. The average volume of tumescent solution infiltrated during TLA was 740mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. Reoperations due to short-term complications never occurred. We observed a major complication rate of 5%, represented by 1 hematoma. Long-term complications comprised one case of implant dislocation and one occurrence of dystrophic scar formation. No cases of capsular contracture needing reoperation, asymmetry, and implant rupture occurred. In total, one individual (5%) requested larger implants. Follow-up time ranged from 30days to 1years. Overall, augmentation mammaplasty is a valuable choice for transgender women aiming to enhance their feminine characteristics and alleviate gender dysphoria. It is imperative for patients to conduct thorough research, grasp the potential pros and cons, and consult experienced healthcare professionals in transgender care. Additionally, tumescent local anesthesia (TLA) has proven to be a safe and efficient method for sub-muscular breast augmentation, providing effective pain control with minimal postoperative complications, resulting in high patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Implant-Based Breast Reconstruction After Nipple-Sparing and Skin-Sparing Mastectomy in Breast-Augmented Patients: Prepectoral or Submuscular Direct-to-Implant Reconstruction?

Patients with breast augmentation facing a breast cancer diagnosis pose unique challenges for both breast and plastic surgeons in terms of treatment and reconstruction. Traditional submuscular direct-to-implant (DTI) breast reconstruction is often considered the standard approach, regardless of the previous implant pocket. However, recent trends in prepectoral reconstruction provide an innovative solution for patients with previous subglandular and submuscular implants. In this study we aimed to share our experiences with DTI breast reconstruction in patients with a history of breast augmentation, with a specific focus on the viability of prepectoral reconstruction. A retrospective review was conducted on 38 patients with previous breast augmentation who underwent either skin-sparing mastectomy or nipple-sparing mastectomy for breast cancer followed by DTI reconstruction between January 2015 and July 2023. Our analysis considered various factors, including previous implant positioning, capsular and implant status, and mastectomy flap thickness (MFT), offering insights into the rationale behind choosing the new implant positioning. Patients with a history of subglandular breast augmentation and an MFT greater than 1 cm were candidates for prepectoral reconstruction. When the MFT was less than 1 cm but flap vascularity was sufficient, a prepectoral reconstruction was performed; otherwise, retropectoral reconstruction was preferred. Patients with submuscular breast augmentation were evaluated similarly, with submuscular reconstruction chosen when the MFT was less than 1 cm and prepectoral reconstruction preferred when the MFT exceeded 1 cm. Immediate prepectoral DTI reconstruction represents a feasible option for specific patients with a history of breast augmentation. Decisions regarding the reconstructive approach are influenced by variables such as mastectomy flap thickness, implant status, and capsular conditions.

The Moufarrege Total Submuscular Augmentation or How to Preserve Nipple Erogenous Sensation in Breast Augmentation

Breast augmentation is currently one of the most common plastic surgery procedures performed worldwide. However, patients who underwent this procedure always complain of postoperative sensory changes at the nipple areolar complex. The nipple nervous system includes a tactile sensation system and an erogenous sensation system, the latter being less described and commonly overlooked by plastic surgeons performing breast augmentations. The erogenous sensation is supplied by the IVth, Vth and VIth intercostal nerves who run laterally on the surface along the muscular aponeurosis. Both subpectoral (dual plane) breast augmentations and sub-glandular breast augmentations present a real and constant risk of damage to these nerves, resulting in a permanent loss of nipple erogenous sensation. In the Total Submuscular Breast Augmentation approach, the implant is inserted behind the four muscles: the external oblique, the serratus anterior, the pectoralis minor and the pectoralis major. This approach will preserve the three intercostal nerves responsible for the erogenous sensation of the nipple. In this article we describe the surgical technique and the advantages of the total submuscular breast augmentation.

Synthetic Reabsorbable Mesh (GalaFLEX) as Soft Tissue Adjunct in Breast Augmentation Revision Surgery.

A significant number of patients with a previous submuscular breast augmentation require a revision surgical procedure during their long-term follow-up period that involves changing the implant pocket from submuscular to subglandular. Reduced soft tissue thickness represents a major concern, discouraging surgeons from undertaking this approach. The aim of this study was to determine whether a synthetic resorbable mesh used as a supplemental covering device was safe and yielded improved soft tissue thickness and protection against capsular contracture in patients undergoing implant plane shift to subglandular. A retrospective review of 34 patients who underwent revision of a previous breast augmentation involving implant change in a subglandular pocket and upper pole GalaFLEX (Galatea Surgical, BD; Franklin Lakes, NJ) mesh coverage was conducted. Onset of minor and major complications was recorded during short- and medium-term follow-up. Patient satisfaction was assessed via an anonymous questionnaire administered 6 months postoperatively. During the follow-up period, which ranged from a minimum of 6 months to a maximum of 28 months, no minor or major complications were reported. In particular, no wrinkling/rippling or significant capsular contracture onset was observed. High levels of patient satisfaction were determined, according to self-reporting questionnaires. The initial results of this preliminary report from this case series demonstrate the safety of GalaFLEX as a supplemental device in terms of improved soft tissue coverage of the implant for complex revisional cases in breast augmentation.

Objective evaluation of volumetric changes during breast augmentation using intraoperative three-dimensional surface imaging

Breast volume estimation and implant size are crucial factors to achieve a symmetrical result in esthetic and reconstructive breast surgery. Although three-dimensional surface imaging (3DSI) has allowed for a better understanding of breast shape, size, and asymmetry during patient consultation, its use has been limited regarding intraoperative decision-making. To validate the intraoperative use of a portable hand-held 3D surface imaging device as an objective tool to assess volumetric changes during breast augmentation surgery. Patients receiving bilateral, submuscular breast augmentation were enrolled for this study. Intraoperative 3DSI was conducted using the Sense 3D scanner, allowing for digitalization of the operating field. Intraoperatively gauged volume changes caused by known implant volumes were compared with digital measurements calculated from 3D surface images of the operating field. Digital intraoperative breast volumes were compared to the pre- and postoperative Vectra XT reference system. Eighty individual breasts of 40 patients were successfully 3D imaged before incision and after wound closure. There was no significant difference between digital breast volumes by intraoperative and outpatient 3DSI. Intraoperative pre- to postoperative 3D breast volume change showed no significant difference to the known implant volume (p=0.124, mean deviation of 5.8±24.3mL and 2.0±9.0%). Our findings showed a high correlation regarding intraoperative digital breast volumetric changes. Intraoperative use of 3DSI yielded objective data during breast augmentation. This novel technique could beneficially impact future breast implant selection, especially in cases with breast asymmetry and the need for differently sized implants.

Preservation of the Implant in Nipple-Sparing Mastectomies: A Retrospective Cohort Study.

Mastectomies are an integral part of breast cancer treatment for many patients.1 Of those patients, a significant number have previously undergone breast augmentation before being diagnosed with breast cancer. Therefore, we developed the novel technique of performing nipple- and implant-sparing mastectomies (NISMs) for women with prior breast augmentations. This study will assess the plausibility of using NISMs versus nipple-sparing mastectomies (NSMs) in this subgroup of patients by comparing the complication rates. Data were collected on age, tumor size, tumor grade, receptors, and the interval between mastectomy and implant exchange for both groups. Descriptive statistics were used to summarize patient characteristics. Independent samples t tests, χ2 tests, and Fisher exact tests were used to compare the NISM and NSM cohorts. Logistic regression was used to assess the association between complications and mastectomy type and was summarized as an odds ratio with a 95% confidence interval. Fifteen patients underwent an NISM and 35 patients underwent an NSM. The overall rate of complications was less in NISM cases than in NSM cases (20% vs 27%). However, this difference was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.18-1.64; P = 0.278). The overall complication rate was lower with NISMs compared with NSMs. Nipple- and implant-sparing mastectomy is a novel, viable, and safe option for patients with breast cancer and a history of submuscular breast augmentation.

Abstract 180: Demystifying Systemic Anaplastic Large Cell Lymphoma After Breast Augmentation: Separating Fact From Fiction

Purpose: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) has been a major concern in patients with history of breast augmentation. Rarely is peri-implant breast swelling, pain and lymphadenopathy associated with other types of ALCL. Here we describe a unique case of systemic CD30 positive ALK-1 negative anaplastic large cell lymphoma (ALCL) causing pain and swelling around a textured breast implant Methods: The clinical course and diagnosis of a patient presenting with right axilla, breast pain and swelling 16 years post-bilateral breast augmentation. Results: We present the case of a 44-year-old female with past medical history significant for bilateral submuscular breast augmentation with textured anatomic saline implants performed in 2002. She presented with late onset peri-implant seroma formation, right breast mass, upper extremity swelling, supra-clavicular, mediastinal and mammary lymphadenopathy and pectoralis muscle swelling. Lymph node biopsy was notable for CD30 positive ALK-1 negative ALCL. Brentuximab vedotin in combination with cyclophosphamide, doxorubicin, and prednisone (Bv-CHP) and brentuximabchemotherapy was initiated. Cytology from the bilateral capsulectomies and removal of saline implants were negative for BIA-ALCL markers. Conclusion: To our knowledge, this is the first documented case report of non-BIA-ALCL systemic ALCL involving a breast implant. Systemic ALCL likely triggered an inflammatory response heightened by the presence of the textured material.Plastic surgeons should be aware of various ways breast implants may be involved in a malignant process. Multi-disciplinary management with chemotherapy and implant removal is recommended. Any reconstruction should be delayed until systemic ALCL has been addressed.

Iatrogenic Symmastia: Causes and Suggested Repair Technique.

Various theories exist to explain the etiology of iatrogenic symmastia. Subglandular over-dissection of the medial breast pocket over the sternum, disruption of midline sternal fascia, oversized implant base diameter, and over-dissection of the medial pectoralis muscle attachments to the sternum are popular explanations. The authors hypothesized that the most common risk factor for iatrogenic symmastia is subpectoral breast augmentation. A retrospective chart review was conducted including all symmastia patients who underwent surgery from January 2008 to April 2018 by a single surgeon (C.L.M.). ASAPS members were also surveyed regarding the etiology and incidence of symmastia in their practice. Twenty-three patients with symmastia were included in the retrospective chart review. All had previous subpectoral breast augmentation. In the ASAPS survey, 91 plastic surgeons reported seeing an average of 2.2 consults for acquired symmastia over the preceding year; 1.9 of the 2.2 (84.9%) acquired symmastia consults previously underwent subpectoral breast augmentation. Most surgeons attributed these patients' symmastia to over-dissection of the medial pectoralis muscle attachments to the sternum. Symmastia is most often caused by pectoralis major sternal dehiscence during subpectoral breast augmentation. In the senior author's experience, all patients with iatrogenic symmastia previously had a submuscular breast augmentation. The ASAPS survey supports multiple causes for symmastia with retromuscular breast augmentation occurring in the majority of patients. Repair of symmastia should include securing Scarpa's fascia to the sternum, reattaching the pectoralis major to the sternum, avoiding another subpectoral implant, and using postoperative modalities to protect the repair.

Sub-muscular Breast Augmentation Using Tumescent Local Anesthesia.

Tumescent local anesthesia (TLA) consists of infiltration of saline solution with lidocaine and epinephrine into the tissues to obtain regional anesthesia and vasoconstriction. The use of TLA in augmentation mammoplasty has been described for sub-glandular positioning. We describe a modified TLA technique for primary sub-muscular breast augmentation reporting our experience during the past 7years. From 2010 to 2017, 300 patients underwent bilateral primary sub-muscular breast augmentation under TLA and conscious sedation. The tumescent solution was prepared with 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. Firstly, the solution was infiltrated between the pectoral fascia and the mammary gland, secondarily, during surgery, under the pectoralis major muscle. The average amount of tumescent solution infiltrated while performing TLA was 740mL per breast. No signs of adrenaline or lidocaine toxicity were reported and conversion to general anesthesia was never required. In all patients, no pain nor discomfort was reported during the pre-operating infiltration and surgical procedure. We reported a major complication rate of 3.3% (4 hematomas and 6 seromas) and a minor complication rate of 6.0% (8 implant dislocation and 10 dystrophic scars formation). TLA represents a safe and efficacious technique for performing breast augmentation surgery with sub-muscular implant positioning. This technique guarantees good pain control during and after surgery and has low incidence of postoperative side effects. Patients subjected to sub-muscular breast augmentation with TLA were satisfied. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

SURGICAL TREATMENT OF BREAST IMPLANTS ROTATION

Relevance. Using anatomical breast implants with high and ultrahigh profile in augmentation mammoplasty provides nearly natural shape of breasts. Using the drop-like shape implants instead of round ones can cause complication called breast implant rotation (BIR), that have negative influence on patients life quality. There is not enough data about the effective methods of surgical treatment of clinically significant rotation.
 Objective of our study was to determine the effectiveness of «neo pocket» upper pole inhancement with mesh for the treatment of BIR after primary submuscular breast augmentation in a postoperative period.
 Materials and methods. The study included 42 women with an average age of 29.4 ± 0.7 years (20 to 39 years) who underwent surgery for a clinically significant (more than 90o) BIR that occurred after the classical primary breast augmentation. Treatment of BIR was performed by enhancement of upper pole of neo-pocket redublication of implant capsule with prolene mesh between the capsule layers and fixation to ribs periosteum and pectoral muscules. The endpoint of the study was the frequency and degree of the prosthesis rotation one year after BIR treatment. Data analysis was performed using the IBM SPSS Statistics 22.
 Results. 13 (31,0%) of patients admitted to hospital for prothesis enlargment and BIR – 29 (69,0%). From 84 number of implants 66 (78,6%) were rotated. Two women (4,7%) had same degree of implants rotation. In all other cases BIR had different angle. Clinically significant rotation of implants was diagnosed in 4 patient: 90 ° / 90 ° two patients; 90° / 150° – one patient ; 90° / 180° – one patient. 38 (90,5%) patients had clinically significant implants rotation. In one year after primary surgery significant BIR (90%) was diagnosed in one patient, who didn’t need breast augmentation, she also had a small rotation of breast on 60о before surgery. From number of breasts, when developed procedure was performed (56), in one case significant BIR was diagnosed, in a patient with preoperative BIR 1800. Significant BIR was diagnosed in 6 (11,5 %) patients, and one patient BIR 60о (1,8 %) and five 300 (8,9%).
 Conclusion: The developed method of «neo pocket» upper pole enhancement by redublication of prothesis capsule with prolene mesh between the capsule layers and fixation to ribs periosteum and pectoral muscules helps to avoid BIR in 98,2% in one year follow up period.

Quantifying Dynamic Deformity After Dual Plane Breast Augmentation.

Dynamic breast deformity (DBD) is characterized by visible distortion and deformity of the breast due to contraction of the pectoralis major muscle after submuscular breast augmentation; fortunately, in most cases, this is not a clinically significant complaint from patients. The purpose of this study is to present a simple method for objectively measuring DBD in patients submitted to dual plane breast augmentation (DPBA). We studied 32 women, between 18 and 50years old, who underwent primary DPBA with at least 1year of follow-up. Anthropometric landmarks of the breast were marked, creating linear segments. Standardized photographs were obtained both during no pectoralis contraction (NPC) and during maximum pectoralis muscle contraction (MPC); measurements of the linear segments were taken through ImageJ imaging software, and both groups were compared. We found statistically significant differences in all analyzed segments when comparing measurements of the breasts during NPC and MPC (p<0.001). Our study proposes a novel, standardized method for measuring DBD after DPBA. This technique is reproducible, allowing for objective quantification of the deformity in any patient, which can be valuable for both patients and surgeons, as it allows for a more thorough discussion on DBD, both pre- and postoperatively, and may help both patients and surgeons to make more informed decisions regarding potential animation deformities after breast augmentation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Late breast implant infections: a delayed MRSA infection from hematogenous spread in an intravenous drug user

Infection following breast augmentation is a rare event, with an incidence of 0–4% in most studies. We present the case of a methicillin-resistant Staphylococcus aureus bilateral breast implant infection in a 42-year-old female, 19 years after submuscular saline breast augmentation. Her history was significant for intravenous drug abuse and concomitant osteomyelitis of the sternum and manubrium. She underwent washout and debridement, with explantation of the breast implants, and long-term intravenous vancomycin. This represents the longest reported occurrence of late infection in breast augmentation and the only report of a breast implant infection due to hematogenous spread/seeding from intravenous drug abuse. Level of Evidence: Level V, risk study.

Commentary on: Functional and Volumetric Analysis of the Pectoralis Major Muscle After Submuscular Breast Augmentation.

Commentary on: Functional and Volumetric Analysis of the Pectoralis Major Muscle After Submuscular Breast Augmentation.

Functional and Volumetric Analysis of the Pectoralis Major Muscle After Submuscular Breast Augmentation.

Dual plane breast augmentation is a technical variation of the submuscular plane described as a technique that reduces contour deformities due to contraction of the pectoralis major muscle and lower risk of double-bubble deformity associated with breast ptosis. Despite improvement in the aesthetic aspect, there is still no consensus whether this technique affects the function of the pectoralis major muscle. The aim of this study was to correlate functional with volumetric changes associated with dissection of the muscle origin in submuscular breast augmentation. Thirty women who desired to undergo breast augmentation were selected prospectively and randomly allocated to 2 groups: 10 patients in the control group and 20 patients in the interventional group, who underwent submuscular breast augmentation. Magnetic resonance imaging and volumetric software were used to assess muscle volume and isokinetic dynamometry was used to assess function of the pectoralis major muscle. Preoperative measurements were compared with those at 3, 6, and 12 months after surgery. Magnetic resonance imaging revealed significant decrease in muscle volume at 6 and 12 months follow-up. The isokinetic test conducted during adduction showed a significant difference in muscle strength between groups from baseline to the 12-month follow-up, and between the 3- and 12-month follow-up. No significant differences in muscle strength during abduction were observed from baseline to the 3-, 6-, and 12-month follow-up. Submuscular breast augmentation reduced muscle strength during adduction 12 months after surgery, but without a significant correlation with volumetric muscle loss.

Volumetric Evaluation of the Mammary Gland and Pectoralis Major Muscle following Subglandular and Submuscular Breast Augmentation.

Volumetric Evaluation of the Mammary Gland and Pectoralis Major Muscle following Subglandular and Submuscular Breast Augmentation.

Volumetric Evaluation of the Mammary Gland and Pectoralis Major Muscle following Subglandular and Submuscular Breast Augmentation: Correction

Volumetric Evaluation of the Mammary Gland and Pectoralis Major Muscle following Subglandular and Submuscular Breast Augmentation: Correction

Correction of small volume breast asymmetry using deep parenchymal resection and identical silicone implants: an early experience.

Virtually all patients presenting for augmentation mammaplasty will exhibit some degree of asymmetry. The use of asymmetric implants to address small- volume breast asymmetry introduces uncontrolled variables into the longevity of postoperative results. We described a novel method of addressing small-volume asymmetry using deep parenchymal resection (DPR) to achieve symmetry prior to insertion of identical implants. We also compared our results with this technique to a cohort of standard augmentation mammaplasty patients. All patients underwent 3-dimensional (3D) imaging during consultation. In patients with small-volume breast asymmetry, a uniform disk of deep parenchymal tissue was resected from the base of the larger breast cone through an inframammary incision. A standard submuscular augmentation was then completed. Five patients (DPR group) with appreciable small-volume asymmetry underwent DPR in the larger breast prior to insertion of identical implants. Fifty-six consecutive patients with no appreciable volume asymmetry (standard group) underwent standard submuscular breast augmentation. Using 3D imaging preoperatively, DPR-group patients had an estimated breast volume asymmetry of 86 ± 58 g and had 55 ± 27 g excised from the larger breast intraoperatively, allowing for insertion of identical implants in each patient. Complications in the standard group included 1 case of rippling and 2 cases of malposition. One case of malposition was noted in the DPR group. No other complications were recorded in either group over 6 months. Our novel method of addressing small-volume breast asymmetry allows for the use of identical implants and presents no increase in early complications.

Late unilateral hematoma after breast augmentation

Late hematoma after breast augmentation is a rare phenomenon with unproven etiology. Five patients presented with a late unilateral hematoma after receiving bilateral, submuscular, smooth, round, silicone gel implants for cosmetic breast augmentation. All patients underwent explantation and capsulectomy. Extensive clinical and histological analysis of all capsules was performed. All patients presented with progressive unilateral breast enlargement with at least a doubling of their breast size. Breast enlargement developed nine, 12, 14, 22 and 38 years, respectively, after initial implant insertion and in the absence of any known trauma. Patients presented for treatment one, three, four, nine and 12 months, respectively, after initially noticing breast enlargement. This enabled a sequential analysis of the events occurring on the surface of the capsule and within the structure of the capsule. Macroscopic and microscopic analysis of all capsules demonstrated multiple areas of recent and older hemorrhage, both within the structure of capsules and on the surface of the capsule. Continuing recurrent bouts of acute hemorrhage were observed even nine and 12 months after initial hematoma development. The position of medium-size vessels within the capsules corresponded to the sites of recurrent bleeding within capsules. Late hematomas presented from nine to 38 years after submuscular breast augmentation with a doubling of breast size. Late hematomas appeared to result from multiple recurrent bouts of bleeding within the structure of the capsules. This leads to recurrent bleeding on the surface of the capsules. Breast enlargement develops progressively over time rather than acutely. Continuing acute hemorrhage persisted up to one year after initial hematoma development. This progression suggests a process analogous to a chronic expanding hematoma that has been described in other areas of the body. Failure to remove a capsule could result in long-term continuing bleeding from vessels within the capsule.

Breast Reconstruction in a Previously Explanted Patient: An Interesting Anatomical Anomaly

Breast Reconstruction in a Previously Explanted Patient: An Interesting Anatomical Anomaly

Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery

BackgroundPatients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anesthesia using the TCI system with propofol and remifentanil would be an effective method of anesthesia in breast augmentation.MethodsThis study recruited 100 patients who underwent breast augmentation surgery from February to August 2011. Intravenous anesthesia was performed with 10 mg/mL propofol and 50 µg/mL remifentanil simultaneously administered using two separate modules of a continuous computer-assisted TCI system. The average target concentration was set at 2 µg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinical effect and vital signs. Oxygen saturation, electrocardiography, and respiratory status were continuously measured during surgery. Blood pressure was measured at 5-minute intervals. Information collected includes total duration of surgery, dose of drugs administered during surgery, memory about surgery, and side effects.ResultsIntraoperatively, there was transient hypotension in two cases and hypoxia in three cases. However, there were no serious complications due to anesthesia such as respiratory difficulty, deep vein thrombosis, or malignant hypertension, for which an endotracheal intubation or reversal agent would have been needed. All the patients were discharged on the day of surgery and able to ambulate normally.ConclusionsOur results indicate that anesthetic methods, where the TCI of propofol and remifentanil is used, might replace general anesthesia with endotracheal intubation in breast augmentation surgery.