PURPOSE: Rib cartilage provides sufficient volume and strength for stabilizing the cartilage framework of the nose; thus, rib cartilage rhinoplasty is considered ideal for secondary rhinoplasty.1–3 However, an inevitable scar remains on the chest wall when harvesting rib cartilage; thus, scaring is a major complication in rib cartilage rhinoplasty.4 For female patients, the incision is generally made along the inframammary fold (IMF) line.1, 2 Female Asian patients frequently complain of both a low and short nose and small breasts; therefore, simultaneous rib cartilage rhinoplasty and inframammary breast augmentation is increasing in popularity. Herein, we introduce a newly developed scar-minimizing method utilizing the predicted new IMF line to harvest rib cartilage and perform inframammary breast augmentation concurrently through one single incision. Moreover, a subcutaneous flap (called an ‘interspace wall flap’) is used to isolate the surgical spaces, reducing complications.
SURGICAL TECHNIQUE: The interspace wall flap is made between the two surgical spaces and is composed of Scarpa’s fascia, deep fat, muscle fascia, and muscle. Because the interspace wall flap is strongly attached to the 5th and 6th rib cartilage and intercostal muscle, the two surgical spaces are completely isolated.
RESULTS: This method has been evaluated in 31 patients (27 with primary breast augmentation, 4 with revisional breast augmentation) who underwent both operations simultaneously. At the current follow-up duration (ranging from 2 to 12 months), all patients are satisfied with the scar, and there have been no complications.
CONCLUSION: The innovative method described above addresses two key issues in simultaneous augmentation rhinoplasty and breast augmentation. First, scaring is minimized by using the same incision for harvesting rib cartilage and performing breast augmentation. Second, an interspace wall flap is used to completely isolate the implant pocket space from the harvesting rib cartilage space, preventing potential complications associated with using the same incision line.
Thus, this method appears to be promising for simultaneous augmentation rhinoplasty and inframammary breast augmentation.
1. Gunter JP, Cochran CS, Marin VP. Dorsal augmentation with autogenous rib cartilage. Semin Plast Surg. 2008;22:74–89.
2. Marin VP, Landecker A, Gunter JP. Harvesting rib cartilage grafts for secondary rhinoplasty. Plast Reconstr Surg. 2008;121:1442–1448.
3.Toriumi DM, Pero CD. Asian Rhinoplasty. Clin Plast Surg. 2010;37:335–352.
4. Wee JH, Park MH, Oh S, Jin HR. Complications associated with autologous rib cartilage use in rhinoplasty. Facial Plast Surg. 2015;17:49–55.