Superomedial Auto-Augmentation: A Novel Technique For Explanation And Core Projection
James Butterfield*1, Lucas Boehm2, Keith R. Sweitzer1, Ashley N. Amalfi3, Bradley Calobrese2
1Surgery, University of Rochester, Rochester, NY; 2Caloaesthetics, Louisville, KY; 3Quatella Center for Plastic Surgery, Rochester, NY
Explantations are on the rise in our patient population given the public awareness of breast implant-associated anaplastic large cell lymphoma, breast implant-associated squamous cell carcinoma, and breast implant illness. Additionally, there has been an emerging interest in a more natural breast aesthetic. This push is driving many of our patients to elect out of an implant entirely and choose autologous methods of breast enhancement. Explantation often results in significant deformity for patients including loss of volume and central projection, particularly with simultaneous capsulectomy. The use of auto-augmentation techniques to combat these deformities has become increasingly popular in the current climate. An inferiorly based flap based off the inframammary fold has been a popular option, but has tenuous blood supply in patients who previously had augmentation performed.
We describe a novel technique for breast auto-augmentation following explantation using a superior pedicle flip under flap in a single stage. This can be performed with or without capsulectomy. A retrospective review of 52 patients who had this auto-augmentation technique performed between January 2021 and December 2022 underwent auto-augmentation following removal of a breast prosthesis by two surgeons (BC and AA) Average patient age 50.0 +/- 11.0 years). A minimum of five months of follow up were required for inclusion.
Total reoperation rate was 13.5%. 5.8% of women chose to have secondary augmentation performed. There was a total complication rate of 34.6%. The most common complications were minor, including fat necrosis (11.5%), superficial surgical site infection (9.6%), nipple ischemia (7.7%) and delayed wound healing (5.8%). One patient had nipple areolar complex loss.
Breast auto-augmentation using a vertical mastopexy pattern with a superior pedicle flip under flap in a single stage for increased projection is a novel technique which provides high rates of patient satisfaction and satisfactory long-term results with a favorable risk profile.
preoperative, intraoperative and postoperative photos
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