AUGMENTASI

MAMMAE &
MASTOPEXY
Anatomy
Jorge I. de la Torre and Michael R. D. Anatomy for plastic surgery of the breast.
Jorge I. de la Torre and Michael R. D. Anatomy for plastic surgery of the breast.
Neligan 7th.
Jorge I. de la Torre and Michael R. D. Anatomy for plastic surgery of the breast.
Neligan 7th.
Jorge I. de la Torre and Michael R. D. Anatomy for plastic surgery of the breast.
 Breast
Augmentation
INCISION
 Inframammary fold
→Submuscular,
subpectoral,
subfascial and
subglandular. Direct
acces
Periareolar→ 2nd, masking the scar
(very small breasts w/ no
inframammary fold). Direct
acces→subglandular, subfascial
Periareolar incision
πD
 Transaxillary
• Well-hidden & imperceptible scar but
compromised accuracy
• High in the axilla, horizontally at a point
just lateral to the lateral margin of the
pectoralis major muscle position the
inframammary fold with precision.
 Pocket Plane
• Complete submuscular →
riding high, tight pocket
• Partial
Submuscular
• Subglandular
Subfascial
 Saline Implant
Advantages • 2 cm incision possible
• cost
• some volume adjustability
• ease of knowledge about
rupture or failure of the
implant and concerns about
‘leaking’.
Disadvantage inherent watery or
s ripply feel.
Silicone Implant
• incision size more than
twice that required
for saline
• cost >>
• no volume adjustability
• no current simple, reliable
method of determining
integrity of the implant.
inherent natural or
tissue-like feel.
 Pre Operative
• Basic breast history
• Previous breast biopsy
• The current bra size, Height and weight.
• Patient's goal, issues such as volume,
shape, ptosis and firmness are common
• Preoperative mammographic screening >
25
 Positional Measurement

Clavicle to nipple → 17
-20 cm,a/symetric?
 3 cm (petite), 9 cm (ptotic), fold degree of stretch is 3 cm or
more, a more projecting implant is indicated
position,
to fi ll out appropriately the lax skin
nipple position, selection of implant envelope. < 3 cm, projecting implant :
projection pressure
 Shaping Measurement
• Desired breast • Medial and lateral
base Diameter pinch thickness
• Implant base
diameter
• Skin Envelope
Characteristics :
tight, moderate or
loose
 Basic technique
Inframammary Fold Subglandular
Breast Augmentation
• Patient marking :
inframammary
(symmetry)
 Post Operative Care
• Oral antibiotics & analgetics ( 1 week)
• Support garment
• Follow up ( 1 week, 6 weeks, 6 months, 1
year)
• Restricted vigorous activity (4 weeks)
 Complication
• Alterations of nipple sensitivity
• Seroma fluid (1st week) →topical antibiotic
• Hematoma → pain, blood loss,
disfigurement, and capsular contracture
• Periprosthetic capsular contracture.
• Infection
 Delayed Complication
• Periprosthetic
capsular
contracture →
operative
intervention (Open
capsulotomy )
• Implant rupture
and deflation
• malposition
• Rippling &
palpability
• breast assymetry
Complication
MASTOPEXY
 The SOS (Sitting, Oblique,
Supine) Marking Technique
• Sitting: midline,
midclavicular point,
breast meridian
 Periareolar technique
• Mild to moderate breast ptosis w/
adequate parenchyma (firm > soft) +
(implan)
• The incisions : superior crescent to
complete donut. Patients who present with
• Advantage : camouflage scar
• Disadvatages : limited movement, scar
widening and decreased breast projection
Cresent Mastopexy
(1) NAC lif ing,
(2) NAC shifting
medially or laterally,
(3) NAC reduction,
(4) repositioning the
NAC inferiorly, or
(5) a combination of
the above
procedures.
Goes technique
 Circumvertical
• Adding a vertical component to a
periareolar skin pattern.
• Larger cases → vertical plication turns
laterally along the inframammary fold as
the redundant skin is taken up.
 Vertical / short Technique
• NAC → reduced (θ: 35–45 mm)
• NAC is elevated on a breast tissue pedicle
to a distance of 21–24 cm from the sternal
notch on the breast meridian
• The inferior margin of the skin excision is
placed some 2 cm cephalad to the
inframammary fold
Augmentation Mastopexy
 Periareolar Augmentation
Mastopexy
• Indications :
inferiorly
malpositioned
NAC and do not
demonstrate a
marked excess in
the skin envelope
• Marking :
Circumvertical mastopexy
Augmentation
 Complication
• Nipple loss
• Scar
• Flap necrosis
• Nipple malposition
• Cosmetic dissapointment