Résumé de communication

Objectives: At the conclusion of this presentation, participants will be able to: Reframe high-volume revision breast augmentation as a structural rather than volumetric problem, recognizing inferior pole failure as the primary cause of poor outcomes. Identify key mechanisms of failure in revision cases, including inferior pole instability, loss of load-bearing support, and the cumulative effects of repeated breast incisions. Understand the indications, advantages, and limitations of a transumbilical endoscopic approach in revision breast augmentation. Introduction: High-volume revision breast augmentation is traditionally avoided due to concerns regarding inferior pole instability, recurrent ptosis, and progressive scar burden. Conventional revision strategies often focus on implant downsizing or additional incisions to regain control, yet frequently fail to address the underlying problem of structural support loss. We propose a technique-driven approach that reframes large-volume revision breast augmentation as a structural challenge rather than a volumetric limitation. Materials / method: A transumbilical endoscopic approach was utilized to perform implant exchange to a 790-cc silicone implant in a revision setting. This access allowed implant and capsular management while avoiding additional breast scars. To address inferior pole structural failure, a bioabsorbable scaffold (GalaFLEX) was strategically applied to reinforce the lower pole and redistribute mechanical load during the healing process. Surgical planning emphasized preservation of existing soft tissue, controlled implant positioning, and long-term stability. Results: After 8-hour operative time, pre-existing 430-cc implants were removed via a transumbilical approach, followed by endoscopic capsulotomy and exchange to 790-cc implants. Inferior pole reinforcement was performed using a bioabsorbable scaffold (GalaFLEX). Postoperative ultrasound surveillance showed no hematoma or seroma from the first postoperative day through follow-up. No infection or capsular contracture was observed. Nipple projection and breast contour were restored to anatomically appropriate positions. No recurrent bottoming out has been observed to date. Conclusion: The technique enabled safe placement of a high-volume implant without additional breast incisions. Inferior pole reinforcement provided immediate and sustained support, maintaining implant position and breast contour throughout follow-up. No early mechanical failure, recurrent bottoming out, or scar-related complications were observed to date. The transumbilical approach also minimized cumulative surgical trauma in a revision setting.