Division of Plastic SurgeryFederal University of São Paulo – EPM.

São Paulo - Brazil

UNIFESP

Breast Augmentation with Transaxillary Approach: The Advantages of a Z Incision. A 344 Case Experience

Authors:

Élvio Bueno Garcia, MD, PhD*

Antonio C. Graziozi, MD, PhD*

Marcel V. A. de Menezes, MD

Natasha Sallum, MD

Lydia M. Ferreira, MD, PhD*

Breast Augmentation with Transaxillary Approach: The Advantages of a Z Incision. A 344 Case Experience

Authors:

Élvio Bueno Garcia, MD, PhD*

Antonio C. Graziozi, MD, PhD*

Marcel V. A. de Menezes, MD

Natasha Sallum, MD

Lydia M. Ferreira, MD, PhD*

This study describes the axillary incision in a Z form in order to facilitate its approach with a

direct access to the pectoralis muscle margin and better aesthetic results in a scar with tension line

breaking.

OBJECTIVE

Nothing to disclose

344 patients were operated aging from 18 to 50 years old between 2004 and 2009.

Inclusion critteria: patients desiring breast augmentation and breasts free of scars. Exclusion critteria: previous breast surgery, ptosis, asymmetry, tubular breast.

MATERIAL AND METHODSMATERIAL AND METHODS

Non endoscopic axillary approach Submuscular plane

Textured silicone gel implants ranging from 175 cc and 350 cc

MATERIAL AND METHODSMATERIAL AND METHODS

The Z incision: located inside the axilla’s hair 2cm each leg of the Z

Skin is moved by traction superiorly towards the pectoralis muscle margin.

MATERIAL AND METHODSMATERIAL AND METHODS

Dissection:made with a rhombus dissectorfrom the upper pole until 2 cm under the inframammary crease

Implant placed through the axillaClosure leaving suction drains

MATERIAL AND METHODSMATERIAL AND METHODS

The Z scar permitted a wide access which facilitated the pectoralis muscle approach. It also abbreviated surgical time since no

subcutaneous tunnel is needed. The scar's aesthetic result was well disguised.

Follow up: 1 to 6 years

RESULTSRESULTS

Z scar in the same patient a 6 months and 4 year follow up

RESULTSRESULTS

Aesthetic result in a 1 year follow up

RESULTSRESULTS

Aesthetic result in a 1 year follow up

RESULTSRESULTS

RESULTSRESULTS

Complication rate:

Seroma …………………………………..….6,17%Unfavorable aesthetic result ………………5,2%

Inframammary fold asymmetry …..……1,7%Implant lateralization ………………..….0,85%Double inframammary crease ……..….0,58%Implant cranially malpositioned ……….1,7%

The Z scar hasn't been prolonged beyond the limits planned.

It could possibly happen with a linear or curved incision when moved laterally by tracion.

DISCUSSIONDISCUSSION

Provides the same result on the breastSmaller and broken lined scarLess noticeable scar

Comparative studies about aesthetic results between different types of scars could be published.

DISCUSSIONDISCUSSION

A standout aesthetic result along An amplified, facilitated and shortened procedure. Inclusion of even bigger implantsSimplified the procedure, revealling to be a favorable choice for  patients undergoing breast augmentation.

CONCLUSIONCONCLUSION