Precise breast implant placement using percutaneous chest wall markings

Area of Science:

• Plastic Surgery
• Surgical Techniques
• Medical Imaging

Background:

• Traditional indelible markers for pre-operative breast markings are prone to removal during surgical preparation.
• Positional changes and parenchymal alterations can further compromise the accuracy of conventional markings.
• A novel approach using methylene blue for rib or intercostal markings is presented to improve marking reliability.

Purpose of the Study:

• To evaluate the efficacy of methylene blue dye for pre-operative breast markings in ensuring accurate implant placement.
• To assess the reliability and outcomes of a surgical technique utilizing rib markings for breast augmentation.
• To compare the symmetry and complication rates of breast implants placed using the methylene blue technique.

Main Methods:

• Pre-operative markings were made on the breast and inframammary crease using an indelible marker.
• Methylene blue dye was injected in small aliquots (0.1 ml) directly over the periosteum of the rib closest to the inframammary fold.
• Care was taken to avoid excessive infiltration of local anesthetic to prevent dye diffusion and maintain accuracy.

Main Results:

• The technique resulted in good symmetry of bilateral breast implants, as evaluated by independent medical officers.
• Post-operative assessments at 3 months showed all results rated as good or very good.
• Follow-up for 39 patients ranged from 3 to 24 months, with no implant-related complications observed.

Conclusions:

• The methylene blue rib marking technique provides a fixed and reliable reference point for accurate breast implant placement.
• The method utilizes the relative immobility of the ribs to overcome challenges associated with traditional markings.
• Potential disadvantages were minimal, including two cases of transient dizziness, with no allergic reactions reported.