Suprapubic Breast Augmentation (SUBA): A Cadaveric Study For a New Anatomic Approach

Breast augmentation is a common aesthetic procedure, often performed alongside abdominal wall repairs such as rectus diastasis or umbilical hernias. Traditional incisions include inframammary, periareolar, axillary, and transumbilical approaches, each with benefits and drawbacks. Inspired by laparoscopic techniques, the suprapubic approach offers a novel anatomical approach that may reduce visible scarring while facilitating concurrent abdominal procedures.

A cadaveric feasibility study was conducted on two embalmed female specimens. A 3 cm suprapubic incision, similar to the Pfannenstiel approach, was used. Subcutaneous tunneling provided access to the retroglandular and retromuscular spaces under laparoscopic guidance. Feasibility, dissection techniques, and operative times were evaluated.

The procedure was successfully completed in both cadavers without major complications. Mean operative times were as follows: subcutaneous access dissection (15-20 min), retroglandular pocket dissection (22-31 min), retromuscular dissection (25-36 min), and implant insertion (2-3 min). Retromuscular dissection was more technically challenging but did not significantly increase operative time. Implant stability was satisfactory in both approaches, with minimal external manipulation required for final positioning. No damage to deep thoracic structures, peritoneal cavity entry, or significant vascular injuries was observed. The learning curve was deemed moderate, with prior laparoscopic experience influencing ease of dissection.

The suprapubic approach for breast augmentation demonstrates anatomical feasibility as a minimally invasive alternative with potential aesthetic and reconstructive advantages. This technique allows for simultaneous rectus diastasis repair and liposuction through a single incision, reducing upper trunk scarring. However, the approach requires advanced laparoscopic skills and further refinement before clinical application. Additional studies assessing long-term outcomes, patient satisfaction, and complication rates are warranted.

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