Postpartum
Involutional Hypomastia: Management by Augmentation Mammaplasty with Submuscular
Textured Saline-Filled Implants
Tarek Ahmed Said (M.D.)
Department
of Plastic Surgery, Faculty of Medicine , Cairo University
Kasr El-Aini Journal of Surgery,
2004; 5 (3) September: 77-86
One of the most common indications for
augmentation mammaplasty is postpartum involutional hypomastia, with or
without a varying degree of ptosis. The goal is to achieve a good and lasting
aesthetically pleasing result, to preserve nipple sensation, and to avoid
the most distressing and difficult to remedy complication; capsularcontracture
around the implant. To achieve these goals, several factors should be taken
into consideration; the biochemical nature of the implant, the surface
of implant envelope, the plane of implantation, the use of povidone-iodine
irrigation, the use of postoperative compression and the prevention of
early hematoma formation and infection. 20 cases of postpartum involutional
hypomastia were managed by submuscular implantation of textured salinefilled implant. The aesthetic result was satisfactory in 95% of cases.
Inframammary approach allowed adequate medial pectoral fibre release in
39 sides (97.5%) with only one case needing correction of unilateral implant
migration by adhesive strapping. The nipple sensation was preserved in
all cases. There were no incidents of capsular contracture or late implant
failure over a 1-year follow up period. The results suggest that the use
of the submuscular plane, the textured surface and the saline filled nature
of the implant greatly minimizes the risk of capsular contracture development
and that the use of inframammary approach makes operation easier, allowing
adequate pocket dissection and muscle medial release and under vision Hemostasis.
It also allows preservation of lateral thoracic nerve responsible for nipple
sensation.
Key words: Postpartum, involutional,
hypomastia, breast atrophy, augmentation mammaplasty, submuscular
