A retrospective study of 220 patients was performed to review surgical design in breast augmentation. Three specific issues were studied: incision site, implant variables, and pocket plane selection. The influence of these three factors on aesthetic results in both primary and secondary cases was the focus of the analysis. No attempt was made to address long-term issues such as capsular contracture or saline implant deflation rates. In 77 primary augmentation patients and 80 unilateral augmentations for symmetry in breast reconstruction, there were the following untoward results: 11 revisions for unilateral malposition, change to a different implant shape, or change to a larger implant size; four deflations of saline implants requiring replacement; and four conversions of saline to silicone gel implants. In 63 secondary cases, there were two hematomas and two infections requiring implant removal and subsequent replacement. Operative technique in breast augmentation is described, as are recommendations for each of the options associated with the three variables studied.
The design of breast augmentation procedures is almost entirely determined by three variables: the selection of incision location, the pocket plane for implant placement (either subpectoral or completely subglandular), and the appropriate implant. Implant-related variables include size, shape, shell texture, filler substance, and final implant fill volume in the case of saline implants. There is no incontrovertible evidence that supports the superiority of one combination of choices over another. However, certain anatomic configurations in primary cases as well as certain problems presented in secondary cases are best treated with a specific combination of options that may differ from a usual preferred approach. This study is a retrospective review that seeks to establish the optimal indications for each of three variable options as they relate to specific types of augmentation problems.