Things to note after breast augmentation surgery

Breast augmentation is a procedure that improves the feel of the breasts by applying breast implants of good quality and size to the pectoralis major muscle to increase the volume of the breasts and improve the shape and symmetry of the breasts. There are many methods of breast augmentation. The most commonly used methods are: silicone capsule prosthesis implants, autologous dermal-fat tissue fascia flap free grafts, pedicled dermal-fat flap filling implants, latissimus dorsi-dermal composite tissue island flap implanted into the dermal-fat muscle flap, and rectus abdominis transfer. The most common of these is the implantation of a silicone capsule prosthesis. Things to note after breast augmentation surgery.

1. Transaxillary incision

Before the operation, the patient stands or sits, and the surgical incision and dissection range are marked on the chest skin with gentian violet. The lower limit of the dissection should be 1 cm below the inframammary fissure, the inner limit is the parasternal line, and the outer limit is the anterior axillary line. Regardless of the size of the breast implant, it should be peeled off within this range, especially the inner and lower edge of the pectoralis major muscle should be separated from the sixth rib and the attachment of the rectus abdominis fascia, otherwise it will affect the shape of the breast.

According to the preoperative plan, the skin and subcutaneous tissue at the top of the armpit were incised along the skin lines to reach the surface of the deep fascia. The incision should be 4 cm long or large enough to fit the index and middle fingers side by side. Note: Do not cut the axillary fat pad to avoid damaging important structures such as axillary blood vessels and nerves. Pull the skin incision medially to expose the lateral edge of the pectoralis major muscle. The deep fascia is incised here, and blunt dissection is performed with the fingers to enter the space behind the pectoralis major muscle. When cutting the deep fascia, be careful to avoid the small arteries and nerves that run down here.

Under the pectoralis major muscle is a potential space of loose connective tissue, which is very easy to dissect with almost no bleeding. However, only the upper part of the cavity can be peeled off with fingers alone, so special instruments are needed to complete the peeling of the entire cavity.

When cutting the skin, subcutaneous tissue and deep fascia, electrocoagulation can be used to stop bleeding, but when stripping the space behind the pectoralis major muscle, no hemostasis or packing is required (do not leave cotton yarn in the space).

Use a small gooseneck retractor to lift the deep fascia incision. It requires certain skills to utilize the fluidity of silicone gel and silicone rubber capsule. If operated properly, it can be completed in a short time.

The lower breast line of breast augmentation patients is mostly high. When making the incision, the incision line should be drawn 1 to 4 cm below the lower line of the breast. Regarding the scope of the dissection, it can be performed in the area from the 2nd rib above to the 6th rib below, from the inner side to the parasternal line, and from the outer side to the anterior axillary line. The incision line is usually slightly curved outward from the vertical line of the nipple and is about 3 cm long.

(1) Cut the skin and subcutaneous fat along the incision line, deep into the muscle fascia.

(2) Cut open the myofascia. In most cases, this is the outer edge of the origin of the pectoralis major muscle. After a slight sharp separation, use your index finger to enter the deep surface of the pectoralis major muscle for blunt separation. Note: The gaps created by peeling must be large enough and free of fiber cords.

(4) Suture the incision in layers.

(5) The bandaging and postoperative treatment at the end of the operation are the same as those for the axillary incision method.

3. Transareolar incision

A semicircular incision 3 to 4 cm long is made around the edge below the areola, and the skin, mammary capsule, mammary gland and lactiferous duct are cut deep into the fascia on the surface of the pectoralis major muscle; a circular cavity with a diameter of 10 to 12 cm centered on the nipple is separated between the underside of the mammary gland and the pectoralis major rib fascia; the folded and shrunken hollow breast prosthesis is implanted into the cavity, and then physiological saline is injected into the empty capsule to expand the empty capsule to an appropriate volume; finally, the incision is sutured.