Harvest of Rib Graft for Rhinoplasty in Breast Implant Patients

Combined cosmetic surgeries are advantageous to patients, requiring only 1 anesthesia administration and the loss of fewer working days. There is no previous study reporting on a submuscular implant placement with the simultaneous reconstruction of a nose deformity using a rib graft. Reconstructions of nose deformities through a rib graft, augmentation mammoplasty, and augmentation mastopexy were performed on 4 female patients (who were 19, 23, 24, and 27 years old) between 2006 and 2016. The patients were taken for operations under general anesthesia. First, the rib graft was taken and the breast implant was placed to prevent contamination. An inframammary incision was made, the skin and the subcutaneous layers were passed, and the pectoral muscle fascia was accessed for the rib graft in all 3 patients. After the perichondrium was dissected, an osteochondral graft was harvested at full thickness. The remaining sharp edges were rasped to avoid damaging the silicone. The perichondrium and the periosteum were sutured edge-to-edge, and the donor area was closed. The harvested grafts were used to produce a spreader graft, a nasal valve graft, an onlay graft, and an L-strut graft. In the early period, no seroma, hematoma, or infections were experienced. There were no ruptures, leakages, capsules, or deformities during the 2- to 10-year follow-up. Primary and secondary rhinoplasties requiring a rib graft can be safely performed simultaneously with a breast implant, provided that the rib stumps are closed with a thick protective layer.