STRATEGIES FOR SATISFACTORY AESTHETIC RESULTS IN BREAST EXPLANT

Abstract

Introduction: The increase in demand for breast explants in clinics has made plastic surgeons face the obstacles of this surgery. Implants cause long-term atrophy in the breast parenchyma and changes in the breasts are very heterogeneous. The main principle of surgery is the preservation of as much tissue as possible and the use of fat grafting whenever possible. Treatments can be with fat grafting, periareolar, vertical or inverted T mastopexy. Method: To describe the authors' experience with some strategies to deal with the challenges of this surgery. Result: We divided the patients into 3 subgroups depending on the degree of ptosis (A, B or C) and set up a treatment protocol for each subgroup. Patients without breast ptosis can only undergo fat grafting; those with small periareolar or vertical mastopexy ptosis; those with major ptosis, inverted T mastopexy. We always use diffuse subdermal, intra and submuscular fat grafting. We set up a scheme to facilitate the decision of the sites to be grafted. Discussion: Saving as much tissue as possible is crucial. We prefer the use of mastopexy with a superior pedicle of lyacir II in cases of greater ptosis due to greater vascular safety. This pedicle fills the upper pole, but leaves the lower pole flat. To solve this, we used medial and lateral pillar foot rotation flap in addition to subdermal, intra and submuscular fat grafting. SIM fixation is essential for stabilizing the horizontal scar and maintaining the aesthetic result. Conclusion: Breast reconstruction after explantation requires a lot of creativity and versatility from the surgeon for a satisfactory result.