Effects of the optimization and upgrading of auxiliary tools on transaxillary dual-plane breast augmentation / 中华医学美学美容杂志

Objective:To improve the multiple-link operation efficiency, effect and satisfaction of transaxillary dual-plane breast augmentation by optimizing and upgrading the configuration of auxiliary tools.Methods:From January 2019 to May 2021, breast augmentation was performed in 130 female patients (aged 32±8 years) in the Cosmetic and Plastic Center of the First Affiliated Hospital of Harbin Medical University. The study was conducted among 63 patients who were eligible for the criteria of high configuration surgery. 67 patients underwent standard configuration surgery. The average operation time, intraoperative blood loss, drainage volume (24 hours after operation), postoperative visual analog scale (VAS) pain score and satisfaction were statistically analyzed.Results:The data of high configuration method and standard configuration method were compared as follows: average operation time was (78.6±12.2) min / (93.1±12.1) min ( t=15.73, P<0.05); the average intraoperative blood loss was (3.1±1.0) ml / (14.4±3.5) ml ( t=13.83, P<0.05); the drainage volume (24 hours after operation) was (37.2±8.2) ml / (61.4±10.9) ml ( t=20.82, P<0.05); the pain score on the first day after surgery was (6.1±1.7) points / (7.5±1.6) points ( t=8.57, P<0.05). The overall satisfaction rate was 97.1±1.6 / 95.6±2.0 ( t=5.58, P>0.001), at 6 months after operation. No severe complications were found during the follow-up period, such as capsular contracture, hematoma, infection and double bubble deformity. Conclusions:The use of ultrasonic knife with delivery bag is an effective optimization and upgrade of the endoscopic assisted transaxillary dual plane breast augmentation. The advantages of this method are obvious, highly efficient, safe, effective and satisfactory. It is worthy of clinical application and promotion.

Transaxillary dual-plane breast augmentation under endoscope combined with autologous fat transplantation / 中华医学美学美容杂志

Objective To investigate the feasibility and clinical effect of transaxillary dual-plane breast augmentation under endoscope combined with autologous fat transplantation.Methods From January 2015 to December 2015,88 patients who accepted augmentation mammoplasty were divided into control group (from January to June) and observation group (from July to December).Patients in control group only accepted transaxillary dual-plane breast augmentation and transaxillary dual-plane breast augmentation combined with autologous fat transplantation was used for patients in observation group.Patients' basic information,surgery-related indicators,recovery situations,complications and patients' satisfactory data were collected.34 patients in control group and 38 patients in observation group were followed up.Results For surgery-related indicators and recovery situations,statistically significant difference was not found in the blood lost,duration of drainage tube and postoperative stay (P＞0.05),but was found in operation time (P＜0.05).And there was no significant difference in terms of surgical effects between two groups (P＞0.05).There were no complications such as hematoma,infection,capsular contracture in two groups.25 patients in observation group were performed B ultrasonic examination 6 months after operation.Multiple cysts were found at the cleavage in only 1 patient and were cured by suction.And the rest B ultrasonic results were negative for pathologic findings such as calcifications,cysts and masses.Conclusions Autologous fat transplantation is useful in minimizing the unaesthetic appearance of the cleavage and the bad feeling of the inframammary fold and thus a proper solution for the patient's breasts with thin soft tissue.

Transaxillary high level dual plane breast augmentation assisted with free style endoscopic technique / 中华整形外科杂志

Objective@#To evaluate the safety, reliability and effectiveness of "free style endoscopic technique" assisted transaxillary high level dual plane breast augmentation; To explore endoscopic techniques that can achieve higher efficiency and better result ; To discover a safe and effective method for dual plane dissection with the help of endoscopy.@*Methods@#Using new endoscopic techniques to perform transaxillary dual plane breast augmentation: ① High level dual plane technique, the muscle division line is about 1.5 cm higher than the original inferior mammary fold, the cephalic side of the muscle is retracted to the lower border of the areola with a special retractor to form a high level dual plane cavity, thus the upper and lower portion of the implant would be covered by pectorilis major muscle, while the rest of the implant was partially under breast parenchyma. ② "Free style endoscopic techniques" , the endoscopy and retractor are not fixed to each other, thus the space is exposed by an assistant with a new designed special retractor, while the operator is concentrate on dissecting with endoscopy in one hand and long tipped bowie in the other hand. ③ Accurate navigate technique, define the dissection border by acupuncture via skin in a 90 degree angle, thus to make the dissection right as preoperative design.@*Results@#There were 1 106 cases underwent this kind of surgery, while 405 of them, whose minimum follow up were 12 months were included in this retrospective study. The follow up period ranged from 12-60 months, the average follow up period is 24.3 months. The average operation time is (1.47 ±0.46) h, the average drainage removal time is (4.23±0.51) d after surgery. The perioperative complication rate is 0.99%, including an incision site change caused by intraoperative bleeding, 1 case of pneumothorax, 2 cases of bleeding after surgery. Long period complication including: 6 cases (1.48%) Ⅲ grade capsular contracture, 21 cases (5.20%) of nipple-areola sensation disorders, implant palpable occurred in 14 case (3.46%), 3 cases (0.74%) implant malposition, 2 cases (0.49%) implant distortion, the total reoperation rate is 2.47%. There was no infection, hematoma, seroma, curtain deformity, double bubble deformity occurred in our study.@*Conclusions@#The high level dual plane techniques not only can solve the deficient soft tissue coverage problem thus to lower the rate of implant palpability, but also can relieve the relationship of the pectorilis major muscle and the inframammary fold(IMF), offering an option to replace Ⅱ and Ⅲ type of dual plane techniques, decrease the risk of curtain deformity and double bubble deformity. The free style endoscopic techniques are very flexible and efficient, with the help of accurate navigate technique, it can archive an accurate cavity dissection, accurate and definite IMF, and a lower complication rate. Though the learning curve is relatively longer, it is really a safe and effective breast augmentation method worthwhile to learn and spread.

Application of the formulas of optimal location in splitting pectoralis major in modified dual-plane breast augmentation / 中华医学美学美容杂志

Objective To evaluate the design formulas of the optimal location for splitting pectoralis major in terms of making type Ⅰ or Ⅱ dual-plane implant pocket.Methods Sixty-five patients with micromastia were collected.Breasts were divided into two types according to the soft-tissue pinch thickness of the lower pole:type Ⅰ (thickness＞2 cm;34 cases) and type Ⅱ (thickness ≤2 cm;31 cases).The optimal levels at which the pectoralis major (PM) was severed were 3/4 or 2/4 of the distance of new inframammary fold for type Ⅰ or Ⅱ dual-plane pockets,respectively.All patients completed the pre-and post-operative BREAST-Q augmentation modules before and 6 months after surgery.The scores were changed into hundred-mark system by QScore software.Results The recovery processes were well-off.The breasts contour was good.Patients reported higher scores of satisfaction with breasts,psychosocial well-being and sexual well-being after surgery than before surgery (62.0±8.9 vs 27.9± 4.3,65.0± 17.2 vs 17.4±8.3,60.5± 14.2 vs 30.3±5.5,P＜0.05).The mean satisfaction score for the overall outcome was 90.6±5.4.However,there was no significant difference in physical well-being between before operation and aftre operation (85.3±9.5 vs 84.7± 10.6).No complications such as severe capsular contracture,or displacement occurred.Conclusions The design formulas make the determining procedure of the optimal location for pectoralis major splitting for two types dual-plane implant pockets easier and more exactly.Our modified design method can provide the implant with the optimal soft tissue coverage,and bring desired and stable breast aesthetic outcomes.The higher satisfaction and quality of life reported by patients indicate that the formulas are feasible and worth to recommend.

Clinical applications of dual plane breast augmentation under endoscope through transaxillary incision / 中华医学美学美容杂志

Objective To introduce the technical key points and clinical efficacy of dual plane breast augmentation under endoscope through a transaxillary incision.Methods By analyzing the 89 surgical cases,we have summarized the key points of the pre-operative design,surgical skills and postoperative management.Results All patients had no uncontrolled bleeding during operation and loss of nipple and areola sensation.71 patients got 6-12 months follow-up,showing that only one case presented with unilateral capsular contraction,and the others had satisfied results.Conclusions Blunt dissection can reduce the risks of uncontrolled bleeding on the inner side of the pocket and the damage of the nerves on the lateral side of the dissecting pocket.The lower inner part,lower part and lower lateral part are the areas that could be sharply dissected by electrocautery under endoscope to achieve the dual plane Ⅰ.The drainage and bandage are necessary after the operation.

The clinical application of dual plane breast augmentation by areolar papillaris incision / 安徽医科大学学报

To analyze the effect of the treatment of dual plane breast augmentation ( one part of the implantation was located behind breast parenchyma and the other part was located behind the pectoralis majior muscle) use areo-lar papillaris incision. Using the areolar papillaris incision complete dual plane breast augmentation. For some breast potsis patients the superfluous areolar papillaris skin was removed and suspension fixation was performed at the same time. Some patients were followed up for 3-months to 2-years. All surgical outcomes were satisfactory with natural breast shapes, and there were no complications such as capsular contracture, prosthesis shift or burst. U-sing the areola papillaris incision can complete dual plane breast augmentation surgery without endoscopic guid-ance;surgery is simple under directvision.

Implant Breast Reconstruction using AlloDerm Sling; Clinical Outcomes and Effect to Capsular Formation

PURPOSE: Breast surgeons usually insert tissue expander or implant beneath the subpectoral-subcutaneous dual plane in breast reconstruction. But sometimes it happens unsatisfactory lower pole fullness, asymmetric inframammary fold and breast shape. To solve all the problem like these, we introduce implant breast reconstruction using AlloDerm sling. METHODS: The AlloDerm sling was used in 13 patients and 18 breasts for implant breast reconstruction. After mastectomy, costal and lower sternal insertion of pectoralis major muscle was detached. Rehydrated AlloDerm was sutured to the chest wall and serratus anterior fascia at the level of inframammary fold downward and to lower border of the pectoralis major muscle upward like crescent shape with tension free technique after implant insertion into the subpectoral-subAlloDerm dual pocket. And we evaluate subpectoral capsule and subAlloDerm capsule histologically for the capsular thickness, amount of myofibroblast and TGF-beta expression. RESULTS: We make satisfactory lower pole fullness, symmetric inframammary fold and breast shape using AlloDerm sling. SubAlloDerm capsule was thin than subpectoral capsule. SubAlloDerm capsule have fewer myofibroblast and lower TGF-beta expression than subpectoral capsule. CONCLUSION: Implant breast reconstruction using AlloDerm sling makes easy to get natural breast shape through satisfactory lower pole fullness, symmetric inframammary fold and implant positioning.

Colgajo de pectoral mayor basado en perforantes internas inferiores: dual plane invertido / Pectoralis major flap based on perforating internal inverted lower-dual plane

El polo inferior de la mama en ocasiones puede estar afectado en su espesor por diferentes causas, tales como el simple paso del tiempo, resecciones oncológicas, extrusiones protésicas por infecciones, seromas, fístulas, etc. Se describe en este trabajo una alternativa quirúrgica para brindar una mayor cobertura en el cuadrante inferointerno de la glándula, utilizando un colgajo del músculo pectoral en su porción distal, basada en la irrigación de sus perforantes internas.

In occasions, an inferior breast pole can be affected in its thickness due to different causes such as merely overtime, oncology resections, implant exposure caused by infection, seromas, fitulas, etc. This paper describes a surgical alternative to provide a greater coverage in the inferior-internal quadrant, empoying a pectoral muscle flap in its distal position based in the irrigation of its internal perforating artery.

The Management of Capsular Contracture: Conversion to "Dual-Plane" Positioning through a Periareolar Approach

PURPOSE: The capsular contracture has been the most common complication of augmentation with breast implant, a side effect quite difficult to treat. The latest trends in the correction of capsular contracture include total capsulectomy or conversion of implant pocket. In this study, in an attempt to correct capsular contracture, the authors performed reoperation which involved capsulectomy through peri-areolar approach and dual- plane conversion. The authors hereby report the clinical results of such correction of capsular contracture and examine the efficacy. METHODS: The authors selected 46 patients who were admitted to the clinic from January 2004 to January 2007 (37 months), and performed dual-plane conversion through solely peri-areolar approach. Two types of operation were done: dual-plane conversion from subglandular plane or from submuscular plane. RESULTS: The average follow-up time after conversion to the dual-plane position was 10 months. During the follow-up period, 83.1% of patients recovered from capsular contracture and were Baker class I, and in 10.9% the condition had relapsed into Baker class II or III contracture. CONCLUSION: This study has proven the effectiveness of the dual-plane conversion operation for correcting established capsular contracture after previous augmentation mammaplasty. In this study, all cases of dual-plane conversion operation was performed through peri-areolar approach, which can prevent the occurrence of visible scar on inframammary fold.

Endoscopic Transaxillary Dual Plane Breast Augmentation

PURPOSE: The transaxillary approach for breast augmentation has been advocated for patients and surgeons for several decades. However, this blind technique had many disadvantages including, traumatic dissection, difficult hemostasis, displacement of implants, and ill-defined asymmetrical location of inframammary crease. In the present study, the precise endoscopic electrocautery dissection was applied to eliminate the limits of blunt dissection throughout the procedures. METHODS: From December 2006 to December 2007, a total of 103 patients with an average age of 29.5 years underwent endoscopic assisted transaxillary dual plane augmentation mammoplasty. The mean implant size was 243 cc with the range between 150 and 350cc. Through a 4cm axillary incision, electrocautery dissection for submuscular pockets was carried out under the endoscopic control. The costal origin of pectoralis muscle was completely divided to expose subcutaneous tissue and to make type I dual plane. RESULTS: Using the endoscopic dissection, we achieved good aesthetic results including a short recovery period, less morbidity, and symmetrical well-defined inframammary crease. Type I dual plane procedure could support the consistent inframammary fold shape and be applied to most patients without breast ptosis. Minor complications did not occur, however, four major complications of capsular contracture occurred. CONCLUSION: In contrast to the era of the blind techniques, endoscopic assisted transaxillary dual plane breast augmentation can now be performed effectively and reproducibly. With Its advantage, the axillary application of endoscopy for augmentation mammaplasty is useful to achieve the optimal cosmetic outcomes.

Periareolar Subfascial Breast Augmentation: Comparison with Submuscular and Dual Plane Breast Augmentation

PURPOSE: Subfascial augmentation mammaplasty was introduced by Dr. Graf in 2000. Subfascial placement of breast implants for augmentation was advocated as an option that has some of the advantages of both the subpectoral and subglandular placement while minimizing the disadvantages of each. The clinical experiences of 23 breast augmentations in the subfascial placement are reported. The indications for this technique are proposed. The incidence of complications is described from clinical experiences and compared with that of other methods. METHODS: From January of 2004 through December of 2005, 23 patients underwent periareolar subfascial augmentation mammaplasty. The mean postoperative follow-up time was 8 months. RESULTS: In comparing the results of the subpectoral augmentation group(57 patients) with those of the dual plane(124 patients) and subfascial groups(23 patients), the total rate of complications didn't represented the significant difference. The benefits of this technique include avoiding hematoma(as seen in the dual plane) and muscle action(in the subpectoral), and minimizing postoperative chest pain(inherent to subpectoral), and the ability to correct ptosis. And also this subfascial technique can be used for changing the plane from submuscular to subfascial in case of the reoperations. CONCLUSION: We're thinking that the periareolar subfascial augmentation mammaplasty would be the very useful tool for the primary and secondary breast augmentations.

Periareolar Subfascial Breast Augmentation: Comparison with Submuscular and Dual Plane Breast Augmentation

PURPOSE: Subfascial augmentation mammaplasty was introduced by Dr. Graf in 2000. Subfascial placement of breast implants for augmentation was advocated as an option that has some of the advantages of both the subpectoral and subglandular placement while minimizing the disadvantages of each. The clinical experiences of 23 breast augmentations in the subfascial placement are reported. The indications for this technique are proposed. The incidence of complications is described from clinical experiences and compared with that of other methods. METHODS: From January of 2004 through December of 2005, 23 patients underwent periareolar subfascial augmentation mammaplasty. The mean postoperative follow-up time was 8 months. RESULTS: In comparing the results of the subpectoral augmentation group(57 patients) with those of the dual plane(124 patients) and subfascial groups(23 patients), the total rate of complications didn't represented the significant difference. The benefits of this technique include avoiding hematoma(as seen in the dual plane) and muscle action(in the subpectoral), and minimizing postoperative chest pain(inherent to subpectoral), and the ability to correct ptosis. And also this subfascial technique can be used for changing the plane from submuscular to subfascial in case of the reoperations. CONCLUSION: We're thinking that the periareolar subfascial augmentation mammaplasty would be the very useful tool for the primary and secondary breast augmentations.

Simultaneous Periareolar Augmentation Mastopexy: Dual Plane Versus Subfascial Plane

PURPOSE: The major drawback of submuscular augmentation of the ptotic breast is a "double-bubble" deformity. If a traditional mastopexy is added to correct the ptosis, there would be additional scars. This article describes simultaneous periareolar mastopexy with dual plane or subfascial breast augmentations. METHODS: A series of 81 patients with grade I or II ptosis underwent the procedure from 1999 to 2005. Out of these, dual plane augmentation was done in 71 cases and subfascial plane in 10. After periareolar skin excision, an incision is made perpendicularly down to the fascia of pectoralis. At the lower pole, all breast implants are inserted into the subfascial plane. In case of upper pole thickness of above 20mm, we inserted the implant into the subfascial plane, whereas below 20mm, we inserted that into the submuscular plane. RESULTS: No major complications were noted and patients' satisfactory score was high. This technique avoids the "double-bubble" deformity and leaves a minimal periareolar scar. CONCLUSION: Simultaneous periareolar mastopexy/ breast augmentation is useful for correction of the ptotic breast, increasing the volume of breast and providing the natural breast shape with minimal scars. We consider that subfascial plane augmentation with periareolar mastopexy to be an alternative for cases with breast upper pole thickness of at least above 20mm.

Simultaneous Periareolar Augmentation Mastopexy: Dual Plane Versus Subfascial Plane

PURPOSE: The major drawback of submuscular augmentation of the ptotic breast is a "double-bubble" deformity. If a traditional mastopexy is added to correct the ptosis, there would be additional scars. This article describes simultaneous periareolar mastopexy with dual plane or subfascial breast augmentations. METHODS: A series of 81 patients with grade I or II ptosis underwent the procedure from 1999 to 2005. Out of these, dual plane augmentation was done in 71 cases and subfascial plane in 10. After periareolar skin excision, an incision is made perpendicularly down to the fascia of pectoralis. At the lower pole, all breast implants are inserted into the subfascial plane. In case of upper pole thickness of above 20mm, we inserted the implant into the subfascial plane, whereas below 20mm, we inserted that into the submuscular plane. RESULTS: No major complications were noted and patients' satisfactory score was high. This technique avoids the "double-bubble" deformity and leaves a minimal periareolar scar. CONCLUSION: Simultaneous periareolar mastopexy/ breast augmentation is useful for correction of the ptotic breast, increasing the volume of breast and providing the natural breast shape with minimal scars. We consider that subfascial plane augmentation with periareolar mastopexy to be an alternative for cases with breast upper pole thickness of at least above 20mm.

Dual Plane Method with Orbital Fat Repositioning in Lower Blepharoplasty

Blepharoplasty is a commonly performed aesthetic surgery, but there is still no commonly used standard method for the correction of orbital fat bulging in lower blepharoplasty. We performed dual plane method by elevating skin flap and muscle flap separately, and then repositioned orbital fat with preserving orbital septum for correction of orbital fat bulging in lower blepharoplasty. Between July, 1998 and June, 2005, one hundred and fifty six patients underwent lower blepharoplasty by author's method. The results were satisfactory in all of the patients. Complications were six cases of hematoma and ten cases of visible scar in lateral canthal area. There was no skin flap necrosis, hyperpigmentation, skin irregularity or ectropion. In lower blepharoplasty for the sufficient excision of skin and operation of orbicularis oculi, we performed precise correction of skin and muscle independently by dual plane approach, by separate elevation of skin flap and muscle flap, and were able to reposition orbital fat easily and safely with preservation of orbital septum.

Periareolar Dual Plane Augmentation Mammaplasty

Although several reports have been introduced about dual plane augmentation mammaplasty, the description of periareolar approach dual plane augmentation mammaplasty was few. This article describes specific characteristics, and different classification and techniques for the periareolar dual plane breast augmentation while postoperative scars resulted from inframammary crease approach caused complaints. A total of 124 patients(248 breasts) had periareolar dual plane augmentation surgery from 1998 to 2004. Anatomic implants were used in 43 cases. Most of the patients were satisfied with the outcomes of periareolar dual plane augmentation. Periareolar dual plane augmentation mammaplasty adjusts implant and tissue relationships to ensure adequate soft-tissue coverage while optimizing implant-breast parenchymal dynamics to offer increased benefits and fewer faults compared to a single pocket location in a wide range of breast types with minimal scars. Two types of dual plane classifications are discussed in this study for the periareolar approach exclusively. The boundaries of retroglandular dissection remain constant, as the costal origin of pectoralis major are divided. Type A dual plane implies that the inferior edge of pectoralis muscle lies below the inferior areolar border, and type B dual plane implies that the inferior edge lies above the superior areolar border.