Clinical Research About Secondary Breast Augmentation Under"Double-plane" Through Axillary Incision With Endoscope

BackgroundBreast augmentation with silicone implants is a popular kind of surgery in plastic surgery. A fibrous capsule would form after prosthesis implantation. However, capsule contraction will lead to deformed appearance of the breast, which is a common complication after the surgery. Till now, there is no definitely effective prevention and therapeutic method for it, and all the methods are at the stage of exploration.ObjectiveThis study aims to observe the effect of secondary breast augmentation under "double-plane" after removing part of fibrous capsule through axillary incision with the assistance of endoscope. In addition, the incidence rate of capsule re-contraction was analysed.Materials and methodsA total of36subjects with contracted capsulemeeting the criteria for grade III or IV according to Barker grading system, no matter the incision location or inserted layer of breast implants, were included in this study. Routine measurements and evaluation were performed preoperatively. In the process of the surgery, axillary incision was used to separate the tissue till the outer layer of the capsule, and the capsule was divided blindly. Then, under the assistance of endoscope, the remnant capsule streaks were resected and the implant was taken out. The free coated capsule was resected too and the turning capsule was incised according to the proposed scope of complete separation line. The starting point of part musculipectoralismajor was cut off to connect the layers of the posterior pectoralis major space and gland space to form a "double-plane". Further, the size and shape of implant prosthesis were determined and wool surface with high quality should be used as much as possible. Negative pressure drainage and local pressure dressing should be applied postoperatively. The follow-up was performed in outpatient service. The evaluation was done according to the combined results from the surgeons and patients. The evaluation standard in this study is a comprehensive one based on breast fitness standards, Baker grade system and improved method after breast augmentation by Yuzhe Chen, as well as our clinical experience. The evaluation level by surgeon is divided into:excellent, good, medium and poor. The results from patients contains: very satisfied, satisfied, basic satisfaction and not satisfied.ResultsThe incisions of all36patients healed at phase I. The follow-up time varied from6months to1year, with an average of8months. According to the evaluation results, the excellent rate from surgeon and satisfaction rate form patients were as follows:97%and94%for breast shape,97%and92%for softness,99%and96%for edge visibility of the implant,99%and99%for change in nipple sensation,100%and100%for activity of dual limb,96%and96%for improving mastoptosis.Thirty-five patients after breast implant showed nice and symmetric appearance as well as good movement no matter standing or supine. There was no "double-peak" deformity. Only1patient showed hard touch at6months postoperatively, and belonged to grade III according to Baker grade system.In conclusion(1)There is no obvious scar when axillary incision was used in the surgery. With the application of endoscopic, the blind view turns into direct one, and operations such as releasing and resecting part of capsule, perfecting lacuna, and forming "double-plane"are all finished through axillary incision. Nice appearance and good movement are attained postoperatively.(2) The incidence rate of capsule re-contractionbelonging to grade III and IV is about2.8%and significantly lower than the reported rate7%-31%.(3) The effect of secondary breast augmentation under "double-plane" after removing part of fibrous capsule through axillary incision with the assistance of endoscope is good, which could serve as a simple and effective way of obtaining a better breast shape. At the same time, re-contraction of the fibrous capsule formed after secondary surgery could be reduced effectively.(4) Capsule contraction could not be prevented totally by this way, so, sound preoperative communication with the patients is needed to avoid unnecessary disputes.