Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2014; 41(04): 407-413
DOI: 10.5999/aps.2014.41.4.407
Original Article

Prevention of Implant Malposition in Inframammary Augmentation Mammaplasty

Yoon Ji Kim
Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
,
Yang Woo Kim
Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
,
Young Woo Cheon
Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
› Author Affiliations
› Further Information
   Permissions and Reprints

Background Implant malposition can produce unsatisfactory aesthetic results after breast augmentation. The goal of this article is to identify aspects of the preoperative surgical planning and intraoperative flap fixation that can prevent implant malposition.

Methods This study examined 36 patients who underwent primary dual plane breast augmentation through an inframammary incision between September 1, 2012 and January 31, 2013. Before the surgery, preoperative evaluation and design using the Randquist formula were performed. Each patient was evaluated retrospectively for nipple position relative to the breast implant and breast contour, using standardized preoperative and postoperative photographs. The average follow-up period was 10 months.

Results Seven of 72 breasts were identified as having implant malposition. These malpositions were divided into two groups. In relation to the new breast mound, six breasts had an inferiorly positioned and one breast had a superiorly positioned nipple-areolar complex. Two of these seven breasts were accompanied with an unsatisfactory breast contour.

Conclusions We identified two main causes of implant malposition after inframammary augmentation mammaplasty. One cause was an incorrect preoperatively designed nipple to inframammary fold (N-IMF) distance. The breast skin and parenchyma quality, such as an extremely tight envelope, should be considered. If an extremely tight envelope is found, the preoperatively designed new N-IMF distance should be increased. The other main cause of malposition is failure of the fascial suture from Scarpa's fascia to the perichondrium through an inframammary incision. As well, when this fixation is performed, it should be performed directly downward to the perichondrium, rather than slanted in a cranial or caudal direction.

Keywords

Mammaplasty - Breast implant - Nipples


Publication History

Received: 25 February 2014

Accepted: 08 May 2014

Article published online:
05 May 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Adams Jr WP, Mallucci P. Breast augmentation. Plast Reconstr Surg 2012; 130: 597e-611e
    CrossrefPubMedGoogle Scholar
  • 2 Alpert BS, Lalonde DH. MOC-PS(SM) CME article: breast augmentation. Plast Reconstr Surg 2008; 121: 1-7
    PubMedGoogle Scholar
  • 3 Youn ES. Importance of the new position of the nipple-areola complex in breast augmentation surgery. Plast Reconstr Surg 2006; 118: 18S-31S
    CrossrefPubMedGoogle Scholar
  • 4 Tebbetts JB, Teitelbaum S. High- and extra-high-projection breast implants: potential consequences for patients. Plast Reconstr Surg 2010; 126: 2150-2159
    CrossrefPubMedGoogle Scholar
  • 5 Tebbetts JB. Augmentation mammaplasty: redefining the surgeon and patient experience. London: Elsevier; 2010
  • 6 Hall-Findlay EJ, Evans G. Aesthetic and reconstructive surgery of the breast. Philadelphia: Saunders; 2012
  • 7 Spear SL, Albino FP, Al-Attar A. Classification and management of the postoperative, high-riding nipple. Plast Reconstr Surg 2013; 131: 1413-1421
    CrossrefPubMedGoogle Scholar
  • 8 Hidalgo DA. Breast augmentation: choosing the optimal incision, implant, and pocket plane. Plast Reconstr Surg 2000; 105: 2202-2216
    CrossrefPubMedGoogle Scholar
  • 9 Cardenas-Camarena L, Ramirez-Macias R. et al. International Confederation for Plastic Reconstructive and Aesthetic Surgery. Augmentation/mastopexy: how to select and perform the proper technique. Aesthetic Plast Surg 2006; 30: 21-33
    CrossrefPubMedGoogle Scholar
  • 10 Spear SL, Seruya M, Clemens MW. et al. Acellular dermal matrix for the treatment and prevention of implant-associated breast deformities. Plast Reconstr Surg 2011; 127: 1047-1058
    CrossrefPubMedGoogle Scholar
  • 11 Poeppl N, Schreml S, Lichtenegger F. et al. Does the surface structure of implants have an impact on the formation of a capsular contracture?. Aesthetic Plast Surg 2007; 31: 133-139
    CrossrefPubMedGoogle Scholar
  • 12 Brink RR. Sequestered fluid and breast implant malposition. Plast Reconstr Surg 1996; 98: 679-684
    CrossrefPubMedGoogle Scholar
  • 13 Mallucci P, Branford OA. Concepts in aesthetic breast dimensions: analysis of the ideal breast. J Plast Reconstr Aesthet Surg 2012; 65: 8-16
    CrossrefPubMedGoogle Scholar
  • 14 Tebbetts JB, Adams WP. Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. Plast Reconstr Surg 2006; 118: 35S-45S
    CrossrefPubMedGoogle Scholar