Page 132 - Read Online

finger and thumb through inframammary incision. The patients were nonsmokers, 1 smoker and 1 patient’s
incorrect positioning of the stitch is not visible without smoking status was not mentioned. Eighteen patients
this maneuver when patient is lying in a supine position. presented with grade I capsular contracture, 3 patients
More commonly, the sliding or tilting of the table may with grade II ptosis and 4 patients had a combination
show minor puckering or dimpling of the skin envelope of grade I and II capsular contracture. Pseudoptosis was
that can be left alone. Once suture incorrect position present in 6, class B ptosis in 6, A/B ptosis in 3, sliding
is established, implant is removed, and sutures are ptosis or water-down deformity in 5 and rippling in
repositioned at a slightly higher level, using previously 5 patients. Average size implant from the initial surgery
scored anterior capsule as a reference point and implant was 334.4 mL (range: 250-340 mL) and the mean implant
is replaced. The procedure can be repeated to assess the size selected for revision surgery was 416 mL (range:
position of the newly position stitch. 260-525 mL). Of 25 patients, 21 patients had a bilateral
procedure whereas the technique was used unilaterally
Wound closure is done using continuous 2-0 Vicryl to
deep fascial layer, subcutaneous 3-0 Vicryl interrupted and in 4 patients for the correction of asymmetry. Mean
intradermal 4-0 continuous Monocryl stitch (Mononcryl follow-up time was 18 months (range: 6-48 months). All
(Ethicon). Once the wound closed and dressed, external patients had a single intravenous dose of predominantly
support to breast envelope is provided using adhesive Augmentin and followed by an oral course for 5 days,
dressings. The external supportive dressings are applied there was no infection noted in the series. In the current
starting from the lower pole and pulling, supporting, and series, no patient required revision surgery following
stabilizing the breast envelope at a higher and desirable MIM. Patient satisfaction data were retrieved from the
position. Support garments are applied, and patients are spreadsheet, 20 patients (80%) were very satisfied with the
discharged on the same day. outcome and 5 patients were satisfied with the results, no
patients showed dissatisfaction with the procedure.
Postoperatively, there is often some puckering of the
skin envelope due to internal stitches. This puckering DISCUSSION
almost always disappears within 4-6 weeks after surgery
[Figure 2a-d]. Augmentation mammoplasty is primarily done either in
Patients are reviewed 2 and 4 weeks later to check for front or behind the muscles. [7,8] All modifications are the
wound healing. Patients are generally allowed to drive extensions of these 2 primary pockets. The existence of
and return to work 10 days following surgery. Patients these 2 planes in each subject has the potential of these 2
involved in physically demanding work are advised to take pockets being used at the same time. Breast ptosis is the
3 weeks off work. slackening and downward descent of the nipple areolar
complex (NAC) and breast envelope in relation to the
[9]
RESULTS inframammary crease as defined by Regnault. The ptosis
correction is commonly performed by using periareolar,
The group included 25 patients with an average age vertical scar or wise pattern markings, depending on the
36.6 years (range: 25-54 years) with mean implant presentation of the breast, wishes of the patient and the
duration 6.4 years (range: 1.5-13 years), 23 of the

a b
a b

c d
c Figure 2: (a) Illustration showing side profile of an implant in
subglandular pocket; (b) illustration showing dissected muscle splitting
Figure 1: (a) Intraoperative picture showing scored anterior skin pocket with anchoring stitch placed between lower border of upper
envelope marked with a Vicryl suture held at its loose end. Below and split muscle and breast envelope at a level just under the nipple areolar
to the right in the picture, lower edge of the upper split muscle is also complex (NAC). Note the relative position of the sixth rib and the nipple
marked with Vicryl suture; (b) anterior capsule/wall of the pocket on areolar complex; (c) illustration showing the implant placed in muscle
the left and lower free edge of upper split muscle on the right, held splitting pocket with a tied anchoring stitch between muscle and breast
separately in forceps before suturing; (c) tied suture knot between the envelope. Note the puckering of the skin below NAC, gathered skin
marked anterior capsule/wall of envelope and lower edge of the upper above NAC and relative position of the sixth rib; (d) implant in its new
split pectoralis major in place muscle splitting position with puckering and skin gathering settled

122 Plast Aesthet Res || Vol 2 || Issue 3 || May 15, 2015