Resumen

Objectives: We have introduced and published a new method of pocket forming for implant placement, which is combination of Tebbett’s dual-plane 2 or 3 and Graf’s subfascial. We named it as dual plane subfascial. We would like to present the results of this technique in 8 years period. Introduction: Breast augmentation is one of the most frequently performed aesthetic surgical procedures in the world. The most important preoperative decisions which influence the final appearance of the augmented breast are the breast implant pocket choice and selection of the most appropriate implant. Described pocket locations are subglandular, subfascial, partially retropectoral, totally submuscular and dual plane. We published and we would like to present our own method of breast augmentation Materials / method: Between January 2016 and December 2023, total of 277 patients were operated using dual plane subfascial breast augmentation(primarily 271 and secondarily 6 cases). The pinch test in the medial pole less than 2,0 cm and in upper pole less than 2,5 cm are indications for this technique. In our modification, in primary cases a dissected flap in front of muscle is fasciocutaneous (not cutaneous as in Tebbett’s technique). The fasciocutaneous flap is finally located inferiorly of pectoral muscle and in front of the lower/ lateral pole of implant(LLP). LLP is covered with fasciocutaneous flap. Results: Hematoma and infection did not occur in any patient in our study. A capsular contracture grade I/II without the need for reoperation occurred in 7 patients. In 2 patients with secondary augmentation minimal bottoming out was noticed (before reoperation patient had significant bottoming out deformity). Minimal palpability of implants is recorded in 11 patients. Conclusion: Dual plane subfascial is a good option in primary breast augmentation with a well set indication especially in the breasts with the upper pinch test less than 25 mm and medial pinch test less than 20 mm. The idea can be followed even in secondary breast augmentation (subglandular to dual plane subfascial conversion). There is additional soft tissue in front of the implant which led to a less implant palpability, especially in thin patient with smaller amount of subcutaneous fat .