摘要

Objectives: One of the most common request from patients is to reduce to minimum the intermammary space in order to obtain a carved décolleté without the needs of bra. Management of intermammary space represents a taboo for most surgeons because there is a high risk of potential symmastia, which is one of the worst cosmetic complication in breast augmentation, that may be difficult to treat properly in revision surgery. The aim of this article is to report author's experience and technique in the safe reduction of the intermammary space in breast augmentation with implants without fat grafting. Introduction: Reduction of intermammary distance with implant is usually discouraged because excessive medial pocket dissection has a high risk of medial implant displacement and symmastia. However, one of the most frequent request from patients in my practice has been the reduction of the intermammary space. Here the author describes his approach in reducing the intermammary distance when using implants without fat. Materials / method: From July 2018 to July 2021, 62 consecutive patients undergoing cosmetic breast enhancement with implant (41 breast augmentation and 21 augmentation mastopexy, totalling 124 breasts) were retrospectively evaluated. Preoperatively, breast features were registered including intermammary space distance that was measure along the inframammary fold at the level of the 4th rib and was 4.7cm on average, ranging from 3.1 to 6.2 cm. Patients’ satisfaction was registered using a specific designed on-line questionnaire including three specific sections on intermammmary distance. Results: The average follow-up time was 20 months (range 12 to 36 months). The average implant volume used was 300 cc (range 245 to 500cc) for breast augmentation cases and 415cc (range from 335 to 500) for augmentation mastopexy cases. All implants were anatomical silicon-gel filled implants with micropolyurethane foam shell. Two cases from the MWL group experienced a minor delayed wound healing which resolved with dressing changes. No implant malposition including symmastia, capsular contracture, rippling or implant rupture were experienced. Intermammary distance was reduced to an average of 2.8 cm, Conclusion: A short intermammary distance is usually a request by patients seeking breast augmentation. The intermammary distance can be safely reduced in all cases both via submuscular and via subfascial approach by a precise medial pocket overdissection and implantation of micropolyurethane foam-coated implant.