Subfascial Ergonomic Axillary Hybrid (SEAH) Breast Augmentation: A Surgical Approach Combining the Advantages of Incision, Pocket, Silicone Gel, and Fat Grafting in Primary and Revision Breast Augmentation Surgery

Abstract

Background Simultaneous association of the axillary approach (AA) with the subfascial pocket (SF) has been proposed for breast augmentation (BA) surgery. New silicone implant technology and recent improvements in autologous fat grafting (AFG) have ushered in a new era for BA. Objectives This study presents the combined subfascial ergonomic axillary hybrid (SEAH) method and evaluates its aesthetic benefits after primary/secondary BA. Methods 42 patients (84 breasts) underwent BA with the SEAH technique; this approach was indicated when the overlying tissue was insufficient to adequately cover the implant. Results Mean patient age was 34.6 years (range: 28–56), mean body mass index was 18.8 kg/m 2 (14.4–26.1). The most common implant (SmoothSilk surface Ergonomix style) volume was 255 cc (175–355), patients received a mean volume of 96 cc of fat (60–145)/breast in the subcutaneous tissue. Average lower pole stretch value was 40.5% (21.75 mm) and 13.1% (9.9 mm) for preoperative to 10 days post-procedure and 10 days to 18 months post-procedure respectively. Postoperative complications included subcutaneous banding in the axilla [n = 3 (7.1%)], small wound dehiscence [n = 1 (2.3%)], and hypertrophic scarring [n = 1 (2.3%)]. No rippling, implant malposition, infection, or fat necrosis was observed during a mean follow-up of 18 months (6–32). Conclusions SEAH is a useful and versatile technique combining the benefits of AFG and implant-based augmentation, particularly with regard to soft-tissue coverage, and avoids the limitations of the submuscular position. The combination of ergonomic gel implants and a SF pocket can yield satisfactory aesthetic outcomes.

Zones for Fat Grafting in Hybrid Breast Augmentation: Standardization for Planning of Fat Grafting Based on Breast Cleavage Units

“…20,21,25,28 Despite the advantages already mentioned in this previous series, 20–28 one drawback of the subfascial technique is related to very thin patients with insufficient tissue coverage. 12,18,28,29 In terms of aesthetic outcomes, the upper/medial borders of the implant may be evident, with a more marked transition near the implant edges. Recognizing these patients early in the breast augmentation planning process and recommending autologous fat grafting in areas considered “risky” can lead to better outcomes and in turn reduce the need for revision operations to correct implant visibility.…”

“…Recognizing these patients early in the breast augmentation planning process and recommending autologous fat grafting in areas considered “risky” can lead to better outcomes and in turn reduce the need for revision operations to correct implant visibility. 18,28…”

A Preliminary Exploratory Study of Autologous Fat Transplantation in Breast Augmentation With Different Fat Transplantation Planes

“…Fat grafting is increasingly used for cosmetic breast augmentation (4). Currently, fat graft retention is more predictable and ideal using standardized techniques (5)(6)(7), but complications that occur after breast augmentation with fat grafting have made it controversial for wider use and further study is required (8).…”

Hybrid breast augmentation: a surgical approach and formula for preoperative assessment of fat graft volume

“…For studies using HBA mean body mass index (BMI) can be relatively normal, and oftentimes underweight. For example, the mean BMI for 1 summarizes the basic characteristics of HBA studies from a focused search of PubMed, Web of Science, Cochrane Library, and Google Scholar databases (5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…Their study found 100% of patients were very satisfied after one year of follow-up, however the anthropometrics of his patients also allowed for larger fat volume injections (BMI: 26 kg/m 2 ). On the other hand, those with underweight BMI such as Maximiliano et al, Munhoz et al [2021], and Munhoz et al [2022] conferred less satisfaction (96.6%, 95.2%, and 94.5% very satisfied or satisfied, respectively), while 3.3%, 4.7%, and 5.4%, were partially disappointed (8,9,11). For physicians, HBA is also a satisfying procedure, with Sforza et al (10) concluding 84.5% of surgeons reported high levels of satisfaction, while 13.3% reported good levels and 4.2% reported fair levels.…”