Muscle-splitting, subglandular, and partial submuscular augmentation mammoplasties: a 12-year retrospective analysis of 2026 primary cases.
BACKGROUND
Augmentation mammoplasty is a commonly performed procedure with a very high satisfaction rate. Various techniques have been described since the report of the first augmentation mammoplasty in 1963. Muscle-splitting augmentation mammoplasty, a technique first published in 2007, has been used by the author for primary and secondary augmentation mammoplasties and for mastopexy with augmentation.


METHODS
A retrospective analysis of data prospectively collected using the Excel spreadsheet was performed. The patients were divided into three groups. The mammoplasty for group A used the subglandular pocket. In group B, the partial submuscular pocket was used for mammoplasties. Both of these groups had their mammoplasties performed between 1999 and 2005. Group C, the third group, included patients who had muscle-splitting mammoplasties between 2005 and 2011.


RESULTS
Group A involved 793 patients who had their augmentation mammoplasties in the subglandular pocket. Of these 793 patients, 751 had the same size implants and were included in the analysis. The mean age of the patients in group A was 30.9±7.98 years (range 18-59 years), and their mean implant size was 317.5 cc±2.05 (range 200-555). In group A, 45.1% (n=339) of the patients were smokers, and 62.2% (n=467) had drains. The majority of the patients (78%) had an overnight stay in the clinic. Hematoma was seen in 2.7% (n=20) of the group A patients. Revision was performed for 6% (n=45). Periprosthetic infection was seen in 0.4% (n=3) and minor wound healing problems in 1.3% (n=10). Group B comprised 110 patients who had mammoplasties performed in partial submuscular pockets. All the patients had the same size implants. The mean age of the group B patients was 33±8.26 years (range 20-58 years), and their mean implant size was 300.6 cc±35.92 (range 205-395). Of these 110 patients, 51.8% (n=57) were smokers, and 94.5% (n=104) had drains. Hematoma was seen in 1.8% (n=2), and revision was performed for 7.3% (n=8) in the submuscular subgroup. Infection was seen in 3.6% (n=4) and minor wound healing problems in 4.5% (n=5). Group C consisted of 1,123 patients who had breast augmentation in the muscle-splitting biplane. Of these 1,123 patients, 914 had the same size implants. The mean age of the patients was 30.0±8.78 years (range 18-67 years), and their mean implant size was 338.2 cc±58.01 (range 170-655). In group C, 33.6% of the patients were smokers, and 8 % had drains. The majority of the patients (93.4%) were treated as day cases. Hematoma was seen in 0.7%, and 1.2% of the patients had revision surgery. Infection was seen in 1.6% (n=15) and minor wound healing in 4% (n=45).


CONCLUSIONS
Muscle-splitting mammoplasty is a technique that can be performed as a day case without drains. The overall complications in the group were significantly lower than with the other two techniques performed by the author.


METHODS
This journal requires that authors assign a 41 level of evidence to each article. For a full description of 42 these Evidence-Based Medicine ratings, please refer to the 43 Table of Contents or the online Instructions to Authors 44 http://www.springer.com/00266 .
Reshape House, 2-4 High Street, West Malling, Kent, ME19 6QR, UK, mrumarkhan@aol.com.
Umar Daraz
UD
Khan
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D018427:Breast Implants; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult