People often say that having a breast implant is unnecessary. After many years working at our unit, and seeing the distress of our young patients with breast hypoplasia, we have quite a different view. When indicated, the insertion of a breast prosthesis, while preserving the breast parenchyma and sensitivity and without compromising lactation, is one of the most worthwhile interventions in plastic surgery.
We have described our technique for breast augmentation through an axillary incision and placement of breast implants with endoscopy in Plastic and Reconstructive Surgery, the leading journal in our specialty.
The prosthesis can be placed in the subfascial or submuscular plane, depending on the result of the pinching test performed to assess the subcutaneous fat: if it is below 1 cm, the insertion of the prosthesis should be submuscular.
To perform endoscopy, we cannot inject gas under the breast (as is done in abdominal laparoscopy) to create an optical cavity through which to see and work, because the gas would spread throughout the subcutaneous space. To solve this problem we designed the Serra Renom Endoscopic Retractor System, manufactured by Snowden Pencer, for which we have five patents registered in the United States.
Using this technique, we insert the breast implant in the submuscular or subfascial plane via a horizontal incision in the top fold of the armpit, so that the scar is hidden. The pocket is totally adapted to the size of the prosthesis and is controlled by endoscopy; in this way, the prosthesis does not rotate or move.
As there is no periareolar scar, we do not touch the glandular breast tissue. This means that neither breastfeeding nor sensitivity is altered and also ensures that the prosthesis does not come into contact with the germs of the breast. The probability of the formation of a biofilm is very low, and so the likelihood of a breast capsule is minimal.
The scar is made in the armpit, behind the pectoralis major muscle and in front of the latissimus dorsi, in the highest horizontal fold. As it is hidden in the armpit, no scar is visible.
Today, the use of an incision in the inframammary fold is regaining popularity. In fact this is a very old technique, the first to be used for breast augmentation. The main reason for its return is the high level of litigation in the US: if the surgeon inserts the prosthesis via a periareolar site and the patient decides to sue on the grounds of a loss of sensitivity in the areola, there is no way to prove otherwise. In addition, we do not favor altering the breast parenchyma to introduce the prosthesis. The blind axillary approach presents many complications because it is impossible to monitor the dissection in the muscle pocket or the bleeding. The inframammary scar in patients with very small breasts is clearly visible and is often unsightly. For all these reasons, we prefer to use our breast augmentation technique with an axillary insertion and under endoscopic control at all times, because it does not alter the breast parenchyma and the scar is hidden inside a fold of the armpit.