Correction of implant ptosis after a transaxillary subpectoral breast augmentation.

Abstract

With the utilization of the transaxillary subpectoral approach for breast augmentation, dissection of the pocket is a procedure that is not done under direct visualization. One can therefore not expect every implant to assume a perfect position. For those implants judged to be too high, a simple further dissection through the same axillary incision will correct the problem. However, for those implants considered to be too low, one has to be able to offer a way to correct this without adding unnecessary scarring on the breast (which is why the patient opted for this approach in the first place). I have developed an easy, fast, and reliable method of correcting the too-low or laterally misplaced implant. In the majority of the cases (75 percent), a correction of the position of the implant can be achieved without further surgery by putting the patient in a specially designed brassiere for the first 2 postoperative weeks. For the remaining 25 percent of the cases, I close the pocket with percutaneous stitching. This means, however, that one has to add one or two further small scars in the inframammary fold, each about 1 cm, but this is a lot shorter than the scar would be with a direct closure of the implant pocket. Such a procedure also means that one has to open the pocket and expose the implant, something that is associated with an increased risk of subsequently developing capsular contracture.