Subglandular-to-Subpectoral Conversion with Mastopexy: The Four-Step Approach

Abstract

Background: Because of the multiplying number of patients undergoing breast augmentation, nonprimary augmentation mastopexy will be increasingly requested in the future; this operation represents an even more significant challenge than primary augmentation mastopexy. The authors describe a standardized approach for subglandular-to-subpectoral implant pocket conversion in mastopexy that provides a tight neopocket with inferolateral muscular support, which minimizes implant displacement complications and allows operative strategies to reduce the risk of bacterial load on implants. Methods: The authors’ technique proposes the following: (1) modified subpectoral pocket, with muscular inferolateral support for the implant; (2) independent approaches to the submuscular pocket and subglandular (preexisting) pocket; and (3) preestablished four-step surgical sequence. The authors collected data from their private practices for 46 patients who underwent the technique from March of 2017 to April of 2020. Patient perception about aesthetic outcomes, photographs from multiple postoperative follow-ups, and surgical complications/reoperation rates were analyzed. Results: Overall results were positive; 89.1 percent of patients reported satisfaction with their aesthetic outcomes. No major complications occurred. The total revision rate was 15.2 percent, but only 2.1 percent in the last year, as the learning curve progressed. Conclusions: Secondary augmentation mastopexy is a complicated procedure. The four-step sequence approach is one reliable option for subglandular-to-subpectoral pocket conversion, once it produced high levels of patient satisfaction while producing low complication rates. Other surgeons’ experiences with the technique and further studies are necessary to validate these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

A Safe Way to Expand Pectoralis Major Muscle in Subglandular to Submuscular Implant Pocket Change

“…When dealing with nonprimary surgery and subglandular to submuscular pocket change, we follow a sequence that combines the pectoralis major and the existing implant capsule to create a new submuscular pocket. 3 In cases where the pectoralis major is atrophic due to previous subglandular implant pressure and/or the posterior capsule is poorly expandable, the volume of the new implant may be severely limited and the risk of muscle rupture increased. However, in such cases, a solution that we refer to as “pocket expansion” creates adequate room for the new implant and helps to prevent pectoralis rupture.…”