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Endoscopic Transaxillary High Dual-Plane Augmentation with Inframammary Fold Lowering: Feasibility and Limitations in
Xuefeng Zhang1, Hongyu Liang2, Yue Liu2
1Department of Aesthetic Surgery, Bravou Plastic Surgery Hospital, No.21, Section 4, Renmin South Road, Wuhou District, Chengdu, 610000, China.
Background:
The correction of breast ptosis using implants alone remains controversial. Given the preference for transaxillary approaches among Asian women, we developed a novel technique: endoscopic-assisted transaxillary high dual-plane breast augmentation combined with moderate lowering of the inframammary fold (IMF). This study aimed to investigate its feasibility and limitations.
Methods:
We retrospectively analyzed patients with varying degrees of breast ptosis who underwent implant-based augmentation between January 2023 and January 2024 using this technique. Data collected included patient demographics, ptosis grade, implant parameters, preoperative and 12-month postoperative breast measurements, and satisfaction scores. Receiver operating characteristic (ROC) curve analysis was performed to identify optimal preoperative thresholds for predicting surgical satisfaction.
Results:
A total of 48 breasts from 24 women were included: 41 with pseudoptosis, 5 with mild ptosis, and 2 with moderate ptosis. At 12 months postoperatively, the vertical distances from the sternal notch to the IMF, to the inferior boundary of the breast contour (IBBC), and from the nipple to the IMF, as well as nipple-to-IMF surface and maximum stretch distances, significantly increased (P < 0.001). The IBBC-to-IMF vertical distance significantly decreased (P < 0.001). Overall satisfaction was 66.67% (70.73% for pseudoptosis, 60% for mild ptosis); all moderate ptosis cases were unsatisfactory. ROC analysis identified optimal preoperative thresholds: 1.80 cm for the nipple-to-IMF vertical distance, 0.95 cm for the IBBC to IMF, and 5.75 cm for the nipple-to-IMF surface distance.
Conclusions:
With proper patient selection, this technique can be effectively applied to improve pseudoptosis and possibly mild breast ptosis, but is not recommended for moderate ptosis.
Level Of Evidence Iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
