title: Can the pectoral fascia integrity be preserved during subfascial breast augmentation through the axillary approach?
abstract: BACKGROUND
  Although many authors recently have reported good results with subfascial breast augmentation, it still is controversial whether the integrity of the pectoral fascia can be preserved. Some authors think the pectoral fascia will be broken during the operation because it is thin and weak. Therefore, this study aimed to investigate whether the integrity of the pectoral fascia can be preserved during subfascial breast augmentation through an axillary incision without endoscopic assistance.
  
  
  METHODS
  For this study, 10 patients underwent subfascial augmentation mammaplasty through the axillary approach. The technique was used for patients with small or moderate breasts. The pockets were made with the fingers. The area beyond the reach of the fingers was dissected using a breast dissector. Then the pocket and major pectoral fascias were examined with an endoscope. The endoscope was used only to inspect the fascia and major pectoral muscle after the subfascial dissection was completed. The fascia and surgical effects were evaluated.
  
  
  RESULTS
  The integrity of 11 (55%) of 20 pectoral fascias in 10 patients was preserved during the surgery. Four fascias (20%) were broken at about the fourth intercostal space or at the fifth costa. In five breasts (25%), the superficial layer of the pectoral muscle was split, but the integrity of the fascia was maintained. All the patients except one with asymmetric breasts achieved satisfactory results. There was no active bleeding, hematoma, infection, or fibrous capsule contracture during the follow-up period.
  
  
  CONCLUSIONS
  The integrity of most pectoral fascias (11 + 5 fascias) could be preserved through the axillary approach during subfascial breast augmentation without endoscopic assistance. Even if the lower portion of the pectoral fascia was broken, this did not interfere with the aesthetic outcome or the normal postoperative recovery.
authors: International Plastic and Aesthetic Center, Nanjing Medical University, Nanjing, Jiangsu, China. hzljd@sohu.com
authors: Lin
authors: L
authors: Jinde
authors: Chen
authors: C
authors: Xiaoping
authors: Zhang
authors: Z
authors: Wanquan
authors: Gao
authors: G
authors: Xia
authors: Xu
authors: X
authors: Ligang
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D018427:Breast Implants; D004724:Endoscopy; D005205:Fascia / Q000033:anatomy & histology*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010369:Pectoralis Muscles / Q000033:anatomy & histology*; D020034:Silicone Gels
chemical_list: D020034:Silicone Gels