Subpectoral-subfascial breast augmentation for thin-skinned patients

Background: Among thin patients, upper pole skin of less than 2 cm on a pinch test is an indication for submuscular implant placement. However, rippling, palpability, and visibility of the implant are frequently observed in the lower and lateral aspects of the breast due to the lack of muscle coverage in the area. To overcome these problems, a subpectoral-subfascial breast augmentation was performed including subfascial dissection of the rectus abdominis, external abdominal oblique muscle, and serratus anterior muscle as one sheet to cover the inferolateral aspect of the implant. Methods: From March 2008 to March 2010, 62 thin patients with hypomastia underwent subpectoral-subfascial breast augmentation. For all these patients, the result of the pinch test was less than 2 cm on the upper pole of the breast and less than 1 cm on the lower and lateral aspect. With a transareolar-perinipple incision, pockets were created such that the superomedial portion was covered by the pectoralis major muscle, and the inferolateral portion was covered by the fascial flap of neighboring muscles. Results: The results were satisfactory, reproducible, and predictable. The implants were not palpable or visible during a mean follow-up period of 19 months due to the inclusion of a fascial flap in all the patients. Conclusions: This technique, which uses the advantages of both subpectoral and subfascial techniques, can offer a high-grade result. Especially for thin patients with less subcutaneous tissue, it provides excellent upper and lower pole coverage and gives the shape of the breast a natural appearance, with no palpability or rippling.