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• W2802146379 abstract "Sir: We read with great interest the article by Reena A. Bhatt, M.D., et al.1 entitled “Transabdominal Breast Augmentation: A Review of 114 Cases Performed over 14 Years.” The authors have done great work by performing two different operations through one incision. However, we wish to discuss this study in greater detail. First, the pectoralis major muscle is a pinnate muscle with its origins on the ribs, medial clavicle, and lateral sternum extending superolaterally. Thus, the accurate subpectoral space might not be guaranteed by means of blind blunt dissection from an inferior to superior direction. As a result, the edge of the pocket for implant placement might not be located precisely. According to our clinical experience, the attachment of the pectoralis major was too tight for dissection; thus, exhaustive dissection by electrocautery should not be eliminated if an optimal outcome is to be achieved. Furthermore, most Asian women have high and tight inframammary folds, which should be much lower after prosthesis insertion. Inframammary folds could be dragged down to a certain extent by removal of excessive abdominal flap with this technique; however, it is passive and imprecise. Second, many candidates for abdominoplasty combined with mammary augmentation had concomitant breast volume loss or resultant ptosis. The goal for these breasts was to maximally free the pectoralis inferiorly and to free the parenchyma from the pectoralis major at the parenchyma-muscle interface to allow the inferior edge of the pectoralis to move upward. As suggested by Tebbetts,2 dual-plane augmentation mammaplasty provides an adequate full lower pole and optimizes implant–soft-issue dynamics; however, it could not be accomplished successfully by means of the authors’ method. Therefore, we strongly recommend use of the endoscope-assisted technique during the procedure. With insertion of the endoscope and electrocautery through the tunnel created previously, surgeons can manage the edge of the pocket and the origins of the pectoralis more precisely under direct vision. Meanwhile, damage of tissue can be diminished maximally.3 With endoscope-assisted technique, the pectoralis can be separated intentionally from parenchyma at the parenchyma-muscle interface to create a dual plane under direct vision, which would apparently optimize implant–soft-tissue dynamics and offer increased benefits. In addition, the inferior origins of the pectoralis can be separated adequately and precisely, and the whole new inframammary fold can be brought down to an appropriate level to achieve a better contour. The endoscopic technique also facilitates hemostasis. Anyway, we appreciate this great innovation brought by Dr. Zienowicz’s group, especially for Asian women, who are genetically susceptible to hyperplastic scars. We believe that after overcoming the drawbacks, this technique will become more mature, which would bring more benefits to patients. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this communication, and have no conflicts of interest to disclose. There was no outside funding for this study. Fawei Xu, M.D.Department of Plastic SurgeryXiasha CampusSir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou, People’s Republic of China Hua Li, M.D.Jiaqin Cai, M.D.Zichun Gu, M.D.Department of Plastic SurgerySir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou, People’s Republic of China Hao Cheng, M.D.Breast Plastic and Reconstructive CenterPlastic Surgery HospitalChinese Academy of Medical SciencePeking Union Medical CollegeBeijing, People’s Republic of China" @default.
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• W2802146379 date "2018-07-01" @default.
• W2802146379 modified "2023-10-16" @default.
• W2802146379 title "Transabdominal Breast Augmentation" @default.
• W2802146379 cites W2047691775 @default.
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• W2802146379 doi "https://doi.org/10.1097/prs.0000000000004524" @default.
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