Authors: Mia Demant, MD, Magnus Balslev Avnstorp, MD and Mia Steffensen, MD
Inframammary incision and subpectoral emplacements of silicone-filled implants
Step 1: Pre-operative markings and incisions
All pre-operative markings should be performed with the patient in the erect position allowing the breast to drape naturally on the chest wall.
- The midline should be marked together with the position of the inframammary creases, which can be joined with a horizontal line to achieve symmetry.
- The upper extent of the dissection can be marked as to prevent over dissection of the upper pole.
- IMF incision is commenced between 7 and 8 cm from the midline/sternal notch and is extended laterally following skin tension lines. Incision length is between 3-5 cm.
- Dissection is carried up obliquely through the subcutaneous tissues in an anterior direction through Scarpa’s fascia until the inferolateral border of the pectoralis major muscle is identified.
Step 2: Getting access to the subpectoral space
The inferolateral origin of pectoralis major muscle is grasped with a tissue forceps and the muscle is divided at its origin from the ribs. Dissection is continued superomedially dividing the muscle progressively while securing hemostasis.
- Division directions: from 6 to 4 o’clock on the right side and 6 to 8 o’clock on the left side.
- The subpectoral pocket is then gently dissected assisted by a retractor.
Step 3: Implantation and closing
With the pocket size and position established, a temporary breast sizer is inserted to assess final implant volume.
- The tissue pocket is irrigated with saline, antibiotic and local anesthetic solutions.
- Following insertion of the final implant, the soft tissue rim is anchored to the chest wall while making sure to protect the implant with a retractor.
- Skin closure is finally achieved.
- 3-M tape followed by pressure dressing, which is replaced with a bra and elastic wrap for the first week.
Discharge the same day or the day after. Specific bra support is maintained for 8 weeks to help stabilize breast implant position. Underwire bra should be avoided for three months.
Post-operative clinical control and photos after 3 months.
Illustrators: Caroline Lilja, med.stud.