BREAST AUGMENTATION USING SUBMUSCULAR ANATOMIC IMPLANTS WITH AXILLARY APPROACH

The axillary approach to place the implant has proven to have many advantages since the scar is hidden within an axillary fold and is technically simple. The submuscular anatomic implants placed with axillary approach provides adequate fullness to the upper pole of the breast and proper volume and projection to the lower pole. The submuscular plane is our choice when the patient has not enough breast tissue to cover the implant avoiding palpation of the edge of the implant in upper quadrants.

It has proven to be an easy and safe technique, providing proper aesthetic results; furthermore, the scar is hidden within the axillary fold.

Placing the anatomic implant with axillary approach, a breast with adequate volume and projection of the lower pole, and desired fullness of the upper pole are achieved.

When the patient has insufficient soft tissue to cover the implant (pinching test< 2 cm), the submuscular plane is our choice because placing the implant at subglandular or subfascial plane would lead to palpation of the edge of the implant in the upper pole of the breast.

Surgical technique
A 4 cm incision is placed coinciding with an axillary fold. Then, the border of the pectoralis major muscle is identified. Assisted by cold lighted retractor we enter the subpectoral plane, under the pectoralis major muscle and over the pectoralis minor muscle which will be untouched.

Pectoralis major muscle attachments to the 4th, 5th and 6th ribs are severed utilizing a round dissector and then, a double blade retractor designed by us (Serra-Renom swivel endoscopic retractor) is placed elevating medially the pectoralis major muscle and laterally the serratus muscle. With the help of the endoscope, bleeding is checked out thoroughly as well as the regularity and symmetry of the pockets. Utilizing an expandable sizer prosthesis we ensure the symmetry of the pockets and the approximate volume of the final implant is assessed.

The implant is placed and the incision closed. Carefully placed bandage avoids implant rotation and reconstructed breast deformities. It is kept in place for 1 week. Patient must sleep in supine position during the first month after the surgery.
We have achieved highly satisfying results in patients when applying this technique obtaining a natural looking breast with an adequate touching feeling.

Placing the implant at the subpectoral plane we are able to obtain a natural looking breast with adequate projection of the lower pole and good upper quadrant fullness. The breast has a natural sense of touch and thanks to the axillary approach the incision is hidden, avoiding the noticeable scar produced by periareolar or submammary incision. Assisted by the cold light and the endoscope symmetrical and regular pockets are performed. We have designed a double blade retractor to facilitate the maneuver. An expandable sizer prosthesis helps us to estimate the volume of the final implant and the symmetry of the pockets is ensured.

A tight bandage is kept for 1 week and the patients are strongly advised to avoid violent movements and must sleep in supine position during 1 month. Any other movement that may displace the implant should be avoided. These are the key elements of our postoperative care protocol.