Multiplane technique for simultaneous submuscular breast augmentation and internal glandulopexy using inframammary crease incision in selected patients with early ptosis

Augmentation mammoplasty is a procedure with a high satisfaction rate. On the other hand, augmentation in a ptotic breast requires conventional mastopexy which has a high surgical morbidity. In selected cases, the multiplane technique, a simultaneous submuscular augmentation with internal glandulopexy, is a procedure which avoids the external scarring of mastopexy. Between June 2005 and October 2008, the author operated on 44 patients (12 unilateral for nipple level asymmetry not exceeding 1.5 cm and 32 bilateral procedures in patients with nipple-areolar complexes (NAC) below the inframammary crease (IMC) but not exceeding 1.5 cm). The procedure is performed under general anesthesia through an IMC incision. The average age of the patient was 33.5 years (range 19–50), and in all but one patient, a round, high-profile cohesive gel silicone implants with an average size of 354 cm3 (range 260–440) in bilateral and 350 cm3 (range 300–440) in unilateral procedures, were used. The average preoperative suprasternal notch to NAC measurement in unilateral (n=12) and bilateral (n=32) procedures was 22.2 cm (range19–24) and 23.2 cm (range 20–26) respectively. The preoperative average NAC distance to IMC distance in bilateral and unilateral cases was 8.03 cm (range 6–12) and 7.2 (range 4–9) cm respectively. The measured postoperative supra-sternal notch to NAC distance, 22.0 cm (range 19.5–23) in unilateral (n=12) and 22.4 cm (range 20–26) in bilateral procedures (n=32) respectively, shows the reduction in suprasternal notch to NAC distance. Postoperative NAC to IMC distance in bilateral and unilateral breasts was 9.3 cm (range 7–11) and 9.1 cm (range 7–10) respectively. When a unilateral procedure is performed, the contra lateral breast is used as a control to compare the results. One patient had an infection and of the 12 unilateral and 32 bilateral procedures, nipple sensation was present in 8 unilateral and 28 bilateral cases. Only one patient with bilateral procedure reported a bilateral loss of nipple sensation in the early part of her recovery. Two patients did have residual ptosis and one requested a bilateral vertical scar mastopexy. The multiplane procedure for submuscular augmentation with internal subglandular mastopexy is an option in selected patients with early ptosis or patients presenting with minor NAC asymmetry in the vertical axis. If necessary, conventional external mastopexy remains a possibility in patients with inadequate results.