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Subfascial Breast Augmentation with Crossed Fascial Sling, Under Tumescent Anaesthesia With or Without Sedation and Lower Periareolar Access

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Abstract

The tumescent technique is very effective for subfascial breast implant surgery. A total amount volume of 330 cc (120/160 cc for each breast) ensures a clean and bloodless field, leading to less postoperative bruising and prolonged local anaesthesia effects. The surgical procedure can be performed with or without associated sedation. Lower periareolar anaesthesia allows for good and painless infiltration of the surgical field, up to the prepectoralis plane. A smooth, vertical dissection reached the pectoralis fascia, which was smoothly opened, leaving the gland adhesions in place. Subfascial pocket dissection was performed, and the implant was then inserted. The fascial sling, consisting of 2 strips of approximately 4/5 cm × 2 cm each, was prepared superiorly and crossed for inferior fixation. One hundred patients were included over 18 months, and all surgeries were performed under tumescent anaesthesia with general sedation. Overall, we did not need to convert from local anaesthesia in general. No complications were observed, and good cosmetic results were achieved. The follow-up periods lasted for 6 months or, in a few cases, for 1 year.

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References

  1. Sim H-B (2018) Revisiting prepectoral breast augmentation: indications and refinements. Aesthet Surg J 39(5):N113–N122. https://doi.org/10.1093/asj/sjy294

    Article  Google Scholar 

  2. Quirós MC, Bolaños MC, Fassero JJ (2019) Six-year prospective outcomes of primary breast augmentation with nano surface implants. Aesthet Surg J 39(5):495–508. https://doi.org/10.1093/asj/sjy196

    Article  PubMed  Google Scholar 

  3. Baxter RA (2005) Subfascial breast augmentation: theme and variations. Aesthet Surg J 25(5):447–453. https://doi.org/10.1016/j.asj.2005.07.006

    Article  CAS  PubMed  Google Scholar 

  4. Benito-Ruiz J (2003) Transaxillary subfascial breast augmentation. Aesthet Surg J 23(6):480–483

    Article  Google Scholar 

  5. Brown T (2012) Subfascial breast augmentation: is there any advantage over the submammary plane? Aesthet Plast Surg 36(3):566–569. https://doi.org/10.1007/s00266-011-9840-7

    Article  Google Scholar 

  6. Duman A, Dincler M, Fndk H, Uzunismail A (2005) Further advantages of using the subfascial implant in terms of capsular formation. Plast Reconstr Surg 115(3):950–952

    Article  CAS  Google Scholar 

  7. Salgarello M, Visconti G (2014) Transaxillary totally subfascial breast augmentation with anatomical breast implants: review of 27 cases. Plast Reconstr Surg 133(2):220e–222e. https://doi.org/10.1097/01prs.0000437235.00306.f6

    Article  CAS  PubMed  Google Scholar 

  8. Graf RM, Bernardes A, Rippel R et al (2003) Subfascial breast implant: a new procedure. Plast Reconstr Surg 111:904–908

    Article  Google Scholar 

  9. Goes JCS, Munhoz AM, Gemperli R (2015) The subfascial approach to primary and secondary breast augmentation with autologous fat grafting and form-stable implants. Clin Plast Surg 42(4):551–564. https://doi.org/10.1016/j.cps.2015.06.017

    Article  Google Scholar 

  10. Goes JCS (2010) Breast implant stability in the subfascial plane and the new shaped silicone gel breast implants. Aesthet Plast Surg 34(1):23–28. https://doi.org/10.1007/s00266-009-9429-6

    Article  Google Scholar 

  11. Tebbetts JB (2001) Dual plane breast augmentation: optimizing implant soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 107(5):1255–1272

    Article  CAS  Google Scholar 

  12. Tebbetts JB (2002) A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg 109(4):1396–1409 discussion 1410–5

    Article  Google Scholar 

  13. Hunstad JP (2010) We LS (2010) Subfascial breast augmentation: a comprehensive experience. Aesthet Plast Surg 34(3):365–373. https://doi.org/10.1007/s00266-009-9466-1PMID: 20112016

    Article  Google Scholar 

  14. Kaplan BJ (2004) Breast augmentation by tumescent anesthesia. Am J Cosmet Surg. https://doi.org/10.1177/074880680402100202

    Article  Google Scholar 

  15. Cohen JA, Lieberman C (2000) Breast augmentation: inferior periareolar technique with local tumescent anesthesia only. Am J Cosmet Surg 17:155–160

    Article  Google Scholar 

  16. Dryden RM, De Backer CM, Remigio D (2000) The use of tumescent anesthesia for breast augmentation. Am J Cosmet Surg 174:207–210

    Article  Google Scholar 

  17. Allen R, Singh SR (2004) The use of well monitored sedation anesthesia for breast augmentation. Aesthet Surg J 24(3):277–279

    Article  CAS  Google Scholar 

  18. Ceccarino R, Di Micco R, Cappelletti R (2019) Aesthetic breast surgery under cold tumescent anesthesia: feasibility and safety in outpatient clinic. Ann Plast Surg. https://doi.org/10.1097/SAP.0000000000001798

    Article  PubMed  Google Scholar 

  19. Bolletta A, Dessy LA, Fiorot L, Tronci A, Rusciani A, Ciudad P, Trignano E (2019) Sub-muscular breast augmentation using tumescent local anesthesia. Aesthet Plast Surg 43(1):7–13. https://doi.org/10.1007/s00266-018-1181-3

    Article  Google Scholar 

  20. Rusciani A, Pietramaggiori G, Troccola A, Santoprete S, Rotondo A, Curinga G (2016) The outcome of primary subglandular breast augmentation using tumescent local anesthesia. Ann Plast Surg 76(1):13–17. https://doi.org/10.1097/SAP.0000000000000215

    Article  CAS  PubMed  Google Scholar 

  21. Mladick RA (1999) Breast augmentation: ease of dissection with the periareolar technique. Aesthet Surg J 19(2):163–164. https://doi.org/10.1053/aq.1999.v19.97193

    Article  Google Scholar 

  22. Brown T (2016) Objective sensory changes following subfascial breast augmentation. Aesthet Surg J 36(7):784–789. https://doi.org/10.1093/asj/sjw005

    Article  PubMed  Google Scholar 

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Correspondence to Crescenzo D’Onofrio.

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D’Onofrio, C. Subfascial Breast Augmentation with Crossed Fascial Sling, Under Tumescent Anaesthesia With or Without Sedation and Lower Periareolar Access. Aesth Plast Surg 44, 1508–1513 (2020). https://doi.org/10.1007/s00266-020-01723-0

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