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Division of Plastic Surgery Federal University of São Paulo – EPM. São Paulo - Brazil UNIFESP Breast Augmentation with Transaxillary Approach: The Advantages of a Z Incision. A 344 Case Experience Authors: Élvio Bueno Garcia, MD, PhD* Antonio C. Graziozi, MD, PhD* Marcel V. A. de Menezes, MD Natasha Sallum, MD Lydia M. Ferreira, MD, PhD* Breast Augmentation with Transaxillary Approach: The Advantages of a Z Incision. A 344 Case Experience Authors: Élvio Bueno Garcia, MD, PhD* Antonio C. Graziozi, MD, PhD* Marcel V. A. de Menezes, MD Natasha Sallum, MD Lydia M. Ferreira, MD, PhD*
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This study describes the axillary incision in a Z form in order to facilitate its approach with a direct access to the pectoralis muscle margin and better aesthetic results in a scar with tension line breaking. OBJECTIVE Nothing to disclose
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344 patients were operated aging from 18 to 50 years old between 2004 and 2009. Inclusion critteria: patients desiring breast augmentation and breasts free of scars. Exclusion critteria: previous breast surgery, ptosis, asymmetry, tubular breast. MATERIAL AND METHODS
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Non endoscopic axillary approach Submuscular plane Textured silicone gel implants ranging from 175 cc and 350 cc MATERIAL AND METHODS
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The Z incision: located inside the axilla’s hair 2cm each leg of the Z Skin is moved by traction superiorly towards the pectoralis muscle margin. MATERIAL AND METHODS
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Dissection: made with a rhombus dissector from the upper pole until 2 cm under the inframammary crease Implant placed through the axilla Closure leaving suction drains MATERIAL AND METHODS
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The Z scar permitted a wide access which facilitated the pectoralis muscle approach. It also abbreviated surgical time since no subcutaneous tunnel is needed. The scar's aesthetic result was well disguised. Follow up: 1 to 6 years RESULTS
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Z scar in the same patient a 6 months and 4 year follow up RESULTS
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Aesthetic result in a 1 year follow up RESULTS
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RESULTS
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RESULTS Complication rate: Seroma …………………………………..….6,17% Unfavorable aesthetic result ………………5,2% Inframammary fold asymmetry …..……1,7% Implant lateralization ………………..….0,85% Double inframammary crease ……..….0,58% Implant cranially malpositioned ……….1,7%
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The Z scar hasn't been prolonged beyond the limits planned. It could possibly happen with a linear or curved incision when moved laterally by tracion. DISCUSSION
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Provides the same result on the breast Smaller and broken lined scar Less noticeable scar Comparative studies about aesthetic results between different types of scars could be published. DISCUSSION
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A standout aesthetic result along An amplified, facilitated and shortened procedure. Inclusion of even bigger implants Simplified the procedure, revealling to be a favorable choice for patients undergoing breast augmentation. CONCLUSION
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