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The breast implant in augmentation mastopexy can be placed In conclusion, single stage mastopexy with augmentation
in front or behind the pectoralis muscle. Muscle splitting in muscle splitting biplane pocket along with appropriate
pocket, where implant lies in front and behind the muscle, use of markings for skin reduction and careful implant size
has been described for augmentation mammoplasty and selection keep the complication and revision rate of the
simultaneous mastopexy with augmentation. [7,15] The pocket revision surgery within an acceptable range.
provides muscle cover to the implant in the upper part of
the breast leaving lower split pectoralis behind the implant Financial support and sponsorship
without being detached from the ribs. The advantages of Nil.
this pocket are many and include undisturbed muscle origin
that prevents animation deformity, implant gets locked Conflicts of interest
up and laterally in between two split slips of pectoralis There are no conflicts of interest.
preventing implant’s upward or lateral displacement. Intact
skin and muscle interface in the upper part of the pocket REFERENCES
maintain the vascular territories of the perforators arising
from the internal mammary and thoracoacromial axis. 1. Biggs TM, Yarish R.S. Augmentation mammoplasty: A comparative analysis.
[7]
These muscular perforators maintain undisturbed blood Plast. Reconstr Surg 1990;85:368-372
supply to the NAC flaps and are severed during subglandular 2. Regnault P. Partially submuscular breast augmentation. Plast Reconstr Surg
pocket increasing vulnerability of NAC flaps. Medially based 1977;59:72-6.
flap is the author’s choice and to date there is no nipple 3. Binelli L. A new periareolar mammoplasty: the “round block” technique.
areolar loss due to vascular compromise. The author has Aesthetic Plast Surg 1990;14:93-100.
reported a revision rate of 1.2% in an earlier report when 4. Wise RL. A preliminary report on a method of planning the mammoplasty.
Plast Reconstr Surg (1946) 1956;17:367-75.
muscle splitting pocket was used for implant placement 5. Lejour M. Vertical mammoplasty and liposuction of the breast. Plast Reconstr
in muscle splitting augmentation when compared to 9.6% Surg 1994;94:100-14.
and 20% revision rate of silicone gel and saline implants 6. Khan UD. Vertical scar mastopexy with cat’s tail extension for prevention of
respectively. [10,16,17] skin Redundancy: an experience with 17 consecutive cases after mastopexy and
mastopexy with breast augmentation. Aesthetic Plast Surg 2012;36:303-307.
In a previously published article, author has suggested that 7. Khan UD. Augmentation mastopexy in muscle-splitting biplane: outcome of
first 44 consecutive cases of mastopexies in a new pocket. Aesthetic Plast
periareolar mastopexy should best be limited to a breast Surg 2010;34:313-321.
where there is an inadequate skin envelope with NAC to 8. Khan UD. Vertical scar with the bipedicle technique: a modified procedure
[13]
IMC distance of less than 5 cm. Vertical scar selection for for breast reduction and mastopexy. Aesthetic Plast Surg 2007;31:337-342.
mastopexy is likely to give best aesthetic appearance when 9. Spear S. Augmentation/mastopexy: “Surgeon, beware”. Plast Reconstr Surg
preexisting NAC to IMC distance is between 5-8 cm. In breasts 2003:112:905-6.
where NAC to IMC distance is 9 cm or more, reduction of the 10. Stevens WG, Stoker DA, Freman ME, Quardt SM, Hircsh EM, Cohen R. Is
one-stage breast augmentation with mastopexy safe and effective? A review
vertical limb of the scars is essential for an acceptable NAC of 186 primary cases. Aesthet Surg J 2006;26:674-81.
to IMC distance otherwise bottoming out is likely to result. 11. Swanson E. Prospective comparative clinical evaluation of 784 consecutive
Periareolar mastopexy can allow a larger implant to be placed cases of breast augmentation and vertical mammoplasty, performed
due to the absence of vertical or vertical and transverse individually and in combination. Plast Reconstr Surg 2013;132:30e-45e.
skin resection and can allow a far more freedom of implant 12. Khan UD. Poly Implant Prothèse (PIP) incidence of device failure and
size selection. However, periareolar mastopexy should be capsular contracture: a retrospective comparative analysis. Aesthetic Plast
Surg 2013;37:906-13.
carefully selected, as it is a nipple elevation procedure rather 13. Khan UD. Aesthetic surgery of the breast. In: Mugea TT, Shiffman MA, editor. Use
than a skin reduction procedure. This type of mastopexy is of nipple-areolar to inframammary crease mesurments to reduce bottoming
best used in selected patients especially in smaller breasts out following augmentation mastopexy. Berlin: Springer; 2015. p. 649-56.
with deficient lower pole skin regardless of the degree of 14. Spear SL, Low M, Ducic I. Revision augmentation mastpexy: indications,
ptosis or in patients with class A ptosis regardless of the operations, and outcomes. Ann Plast Surg 2003;51:540-6.
skin envelope. Too ambitious use of periareolar markings in 15. Khan UD. Muscle-splitting breast augmentation: a new pocket in a different
Plane. Aesthetic Plast Surg 2007;31:553-558.
advanced ptosis along with skin excess may results in scar 16. Khan UD. Muscle-splitting, subglandular, and partial submuscular augmentation
stretching associated with flattened nipple areolar complex mammoplasties: a 12-year retrospective analysis of 2026 primary cases.
and an inadequate skin envelope reduction. A high number Aesthetic Plast Surg 2013;37:290-302.
of revision surgery is reported when periareolar mastopexy 17. Calobrace MB, Herdt DR, Cothron KJ. Simultaneous augmentation/
has been used for mastopexy with augmentation. [10,18] mastopexy: a retrospective 5-year review of 332 consecutive cases. Plast
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Similarly when vertical mastopexy was used as “All-Season” 18. Stevens WG, Freeman ME, Stoker DA, Quardt SM, Cohen R, Hirsch EM.
markings, 28% skin redundancy and persistent ptosis was One-stage mastopexy with breast augmentation: a review of 321 patients.
reported. [11] Plast Reconstr Surg 2007;120:1674-9.

Plast Aesthet Res || Vol 3 || Issue 1 || Jan 15, 2016 25