Abstract

BERROCAL-REVUELTAS, M.. Mastopexy with implants: tri-planar technique with fish tail flap in breast with poor quality coverage. Cir. plást. iberolatinoam. [online]. 2013, vol.39, n.4, pp.348-359. ISSN 1989-2055.  https://dx.doi.org/10.4321/S0376-78922013000400005.

Primary augmentation/mastopexy is an increasingly popular procedure that requires careful preoperative planning and surgical execution. Breasts disfigured by prolonged breastfeeding and/or massive weight loss are especially challenging, with numerous factors contributing to the risk of unsatisfactory long-term results. Authors have cited striated skin, little subcutaneous tissue, loss of breast parenchyma and poor quality of coverage as factors that make successful enhancement especially challenging. With retromuscular placement of implants, surgeons must also consider the potential for double breast contour, asymmetry, and implant displacement. The objectives of this study are to describe the new triplanar method as a useful alternative for primary augmentation/mastopexy to attain better results in patients with poor quality coverage, and to analyze the results obtained in a large patient group utilizing the triplanar technique. This is an observational, descriptive, prospective study, conducted in a group of 268 patients diagnosed with breast ptosis and hypotrophy with poor quality and striated skin, limited subcutaneous tissue, and breast parenchyma loss secondary to prolonged breastfeeding and massive weight loss. All patients underwent primary breast augmentation/mastopexy with silicone implants and the triplanar method described by the author, during the period from January 2004 to January 2013 at Bocagrande Hospital in Cartagena, Colombia. The design is based on the principles of the vertical technique described by Lassus or Lejour or through "J" technique described by the author. The triplanar method is based on three levels of coverage of the implant. Plane I: submuscular, to cover the upper two thirds of the implant. Plane II: dermoglandular flap with two triangular distal extents of adipose tissue in the form of a tail fish, to cover the lower third of the implant and the free edge of the pectoral muscle. Plane III: coverage of the lower pole of the breast by suturing the medial and lateral pillars to reshape the breast cone. All patients received round silicone implants with textured surface and an average volume between 200 and 275 cc. A smooth and naturally contoured result was observed in all patients. Complications: temporary or transient hypertrophy of the scar in 15 patients; small hematomas in 2 patients; recurrent mild ptosis after 2 years postop in 4 patients. To conclude, the results obtained with this technique are very satisfactory for all patients and long terms results are still favorable after 10 years.

Keywords : Mammary augmentation; Mastopexy; Mammary ptosis; Silicone implants.

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