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The Use of a Retromammary Adipofascial Flap in Breast Augmentation for Patients with Thin Soft Tissue

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  • Breast Surgery
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Abstract

Background

In patients with a thin soft tissue breast envelope, lower pole implant palpability is a postoperative sequela that concerns patients. Anatomically, the lower aspect of the breast near the inframammary fold lacks sufficient soft tissue to cover the breast implant after augmentation.

Methods

A transareolar incision was made, and subcutaneous dissection was performed. The dissection first proceeded caudally to the lower aspect to the breast parenchyma. The dissection then changed direction and moved cephalad to the mid breast or nipple region. The fatty tissue and pectoralis muscle fascia were cut transversely at this level, and the dissection was reversed caudally in a subfascial plane to the new inframammary fold region. This maneuver created a retromammary adipofascial flap.

Results

A total of 368 breast augmentations were performed in 184 patients. Breast implants were inserted in the subfascial plane in 40 patients (21.7%) and in the subpectoral–subfascial plane in 144 patients (78.3%). A total of 368 breast implants were inserted, including 140 smooth cohesive silicone implants (38.0%), 2 textured round implants (0.5%), and 226 anatomic-type implants (61.5%). A cadaveric dissection revealed that a retromammary adipofascial flap measuring 3–4 mm in thickness can be acquired. Capsular contracture occurred in six breasts (1.7%).

Conclusions

During breast augmentation, an inferiorly based retromammary adipofascial flap can be created to help cover the lower pole of the breast from implant palpability. This is helpful especially in patients with thin skin, hypoplastic breasts, or constricted breasts.

Level of Evidence IV

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Authors and Affiliations

  1. Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Hyun Ho Han

  2. Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, USA

    Kenneth K. Kim & Kee Hoon Lee

  3. Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea

    In-Beom Kim

  4. Apgugeong Avenue Plastic Surgery Clinic, Seil Bldg 6 fl., 11, Nonhyeon-ro 171-gil, Gangnam-gu, Seoul, 06030, Korea

    Paik Kwon Lee

Authors
  1. Hyun Ho Han
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  2. Kenneth K. Kim
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  3. Kee Hoon Lee
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Corresponding author

Correspondence to Paik Kwon Lee.

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Conflict of interest

The authors declare that they have no conflict of interest and no financial support.

Ethical Approval

This study was conducted in accordance with the principles of the Declaration of Helsinki, and all patients provided written informed consent prior to enrollment.

Electronic supplementary material

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Subfascial pocket dissection

Subpectoral-subfascial pocket dissection

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Han, H.H., Kim, K.K., Lee, K.H. et al. The Use of a Retromammary Adipofascial Flap in Breast Augmentation for Patients with Thin Soft Tissue. Aesth Plast Surg 42, 1447–1456 (2018). https://doi.org/10.1007/s00266-018-1215-x

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  • DOI: https://doi.org/10.1007/s00266-018-1215-x

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