Intramuscular plane for breast augmentation with a silicone implant

CAMILLO, FRANCISCO CARLOS

FRANCISCO CARLOS CAMILLO ^**Corresponding author: Francisco Carlos Camillo, Rua Independência 2586, Toledo, PR, Brazil, Zip Code 85902015, E-mail: franciscocarloscamillo@gmail.com

Clinic of Plastic and Reconstructive Surgery Camillo, Toledo, PR, Brazil.

https://orcid.org/0000-0002-3596-5692

*Corresponding author: Francisco Carlos Camillo, Rua Independência 2586, Toledo, PR, Brazil, Zip Code 85902015, E-mail: franciscocarloscamillo@gmail.com

Conflicts of interest: none.

Figures (17)
Tables (3)

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Video 1A and 1B
Patients with prostheses in the intramuscular plane, contracting the pectoralis major muscle to show the minimum animation of the breasts.

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Figure 1
Line 1 represents the outer edge of the pectoralis major muscle. Line 2 is parallel and 2 cm medial to line 1, marking the position of the incision in the anterior lamina of the deep fascia that lines the pectoralis major muscle.

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Figure 2
Illustrative drawing of a sagittal section of the breast and chest wall. 1- Transverse fascicles at the level of the third rib. 2- Green line: represents the division site of the pectoralis major muscle (PMM) to form the intramuscular plane. 3- Floor of the pocket, consisting of half the thickness of the PMM (posterior flap), posterior layer of the deep pectoral fascia (black line exactly behind the posterior flap) and fat pad (yellow line behind the posterior layer of the deep pectoral fascia). 4- Fascial cleft - blue line (retromuscular plane).

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Figure 3
A. Initial separation between the superficial and deep muscle fascicles of the pectoralis major muscle (PMM) over the fifth intercostal space. B. Separation between the superficial and deep fascicles of the PMM over the fifth rib. C. Separation between the superficial and deep fascicles of the PMM over the fourth rib.

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Figure 4
A. Separation between the superficial and deep fascicles of the pectoralis major muscle over the third rib, creating the intramuscular store. B. Sequence of dissection of the pocket through the groove.

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Videos 2A to 2K
Temporal sequence of the intramuscular technique.

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Figure 5
Illustrative drawing of the prosthesis in the intramuscular plane.

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Video 3
It was obtained from a patient initially submitted to an intramuscular technique for breast augmentation. In the first postoperative year, she presented residual ptosis and underwent mastopexy. Intraoperatively, we can observe the viability of the anterior and posterior flaps.

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Figure 6
Preoperative period of a 25-year-old patient; Intramuscular plane, smooth prosthesis - 410 g.

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Figure 7
Postoperative period of a 25-year-old patient; Intramuscular plane, smooth prosthesis - 410 g.

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Figure 8
Preoperative period of a 22-year-old patient; Intramuscular plane, smooth prosthesis, 300 g.

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Figure 9
Postoperative period of a 22-year-old patient; Intramuscular plane, smooth prosthesis, 300 g.

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Figure 10
Preoperative period of a 29-year-old patient; intramuscular plane, smooth prosthesis, 325 g.

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Figure 11
Postoperative period of a 29-year-old patient; intramuscular plane, smooth prosthesis, 325 g.

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Figure 12
Periprosthetic capsule formed on the posterior muscular flap of the intramuscular pocket. The pinching and traction of a free capsule and away from the ribs can be observed.

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Figure 13
Pectoralis major muscle at the height of the third rib. At this level, the muscle is compact, and we cannot separate the fascicles (blockage to the prosthesis ascent).

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Figure 14
Posterior capsule formed over the ribs in the retromuscular plane. The capsule cannot be pinched or pulled, it is closely adhered to the ribs.

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COLABORAÇÕES FCC Análise e/ou interpretação dos dados, Análise estatística, Aprovação final do manuscrito, Aquisição de financiamento, Coleta de Dados, Conceitualização, Concepção e desenho do estudo, Gerenciamento de Recursos, Gerenciamento do Projeto, Investigação, Metodologia, Realização das operações e/ou experimentos, Redação - Preparação do original, Redação - Revisão e Edição, Software, Supervisão, Validação, Visualização.

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Chart 1
Complications and benefits related to each plane.

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COLLABORATIONS FCC Analysis and/or data interpretation, Conception and design study, Conceptualization, Data Curation, Final manuscript approval, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Realization of operations and/or trials, Resources, Software, Supervision, Validation, Visualization, Writing - Original Draft Preparation, Writing - Review & Editing

Breast plane	Complications	Benefits
Subglandular	1. Capsular contracture. 2. Rippling. 3. Short and medium-term atrophy of the mammary gland. 4. Skin distension. 5. Earlier ptosis. 6. Improved visibility and palpability of implant edges. 7. Artificial appearance.	Shorter surgical time. Greater control of bleeding. Greater control of the definition of the submammary fold. Greater control of breast shape. Faster postoperative recovery. Minimal animation with chest contraction. Periprosthetic capsule distant from the rib cage.
Subfascial	1. Rippling and capsular contracture with an intermediate incidence in relation to the subglandular and retromuscular planes.	1. Good tissue coverage of the prosthesis. 2. Periprosthetic capsule distant from the rib cage. 3. Contours in the medial quadrants with great definition.
Retromuscular: (Dual Plane, retropectoral and total submuscular)	1. Implant displacement above the second intercostal space. 2. Wide pocket. 3. Capsule adhered to the rib cage. 4. Blindspot in the second intercostal space. 5. Extreme difficulty in total capsulectomy. 6. Greater animation with muscle contraction.	1. Excellent implant coverage in the upper and medial quadrants. 2. Lower incidence of capsular contracture and rippling. 3. Naturalness of shape and contour. 4. Shorter surgical time. 5. Lesser glandular atrophy in the short and medium-term.
Intramuscular	1. A case of seroma caused by excess muscle debris. 2. Less muscle coverage when compared to the retromuscular plane. 3. Longer surgical time.	1. Periprosthetic capsule distant and free from the rib cage. 2. Intermediate coverage between the retromuscular and subfascial planes. 3. Less animation with muscle contraction (videos 1A e 1B). 4. Stability in implant positioning with less displacement.

COLLABORATIONS
FCC	Analysis and/or data interpretation, Conception and design study, Conceptualization, Data Curation, Final manuscript approval, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Realization of operations and/or trials, Resources, Software, Supervision, Validation, Visualization, Writing - Original Draft Preparation, Writing - Review & Editing

COLABORAÇÕES

FCC

Análise e/ou interpretação dos dados, Análise estatística, Aprovação final do manuscrito, Aquisição de financiamento, Coleta de Dados, Conceitualização, Concepção e desenho do estudo, Gerenciamento de Recursos, Gerenciamento do Projeto, Investigação, Metodologia, Realização das operações e/ou experimentos, Redação - Preparação do original, Redação - Revisão e Edição, Software, Supervisão, Validação, Visualização.

[1] *Corresponding author: Francisco Carlos Camillo, Rua Independência 2586, Toledo, PR, Brazil, Zip Code 85902015, E-mail: franciscocarloscamillo@gmail.com

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Intramuscular plane for breast augmentation with a silicone implant

ABSTRACT

Introduction:

Methods:

Results:

Conclusion: