A Simple and Fast Technique to Perform Submuscular Breast Augmentation

The benefits of placing breast implants below the muscle very often outweigh placing them above the muscle. This dissection plane is less vascularized than the retroglandular one, and favoring this option may reduce hematoma incidence. Furthermore, the correct submuscular dissection is not easy to perform (mostly for beginners); thus, the pocket is not carried out quickly. To solve these problems, we present an alternative submuscular surgical technique, which uses hydrodissection to delimitate the submuscular pocket dissection. We analyzed the results of 11 patients with breast cancer who underwent mastectomy and breast implant reconstruction and eight patients who underwent breast implant augmentation from March 2016 to September 2017. First, the submuscular plane is accessed via an inframammary incision, then creates a small cavity at the lateral border of major pectoralis muscle, above the distal insertion of minor pectoralis muscle. After that, a 60-mL syringe (catheter tip) is inserted and a tumescence solution is infiltrated (epinephrine and saline solution). With hydrodissection, the soft tissue is separated using the gentle force of the water-jet (atraumatic dissection); the epinephrine allows vasoconstriction and an easier preventive hemostasis is established. Minimum follow-up after surgery was 1 year, with an average of 14.8 months. Among the treated patients, the percentage of complications was extremely low and time of surgery was very fast. This technical note explains a very simple, economical, and less time-consuming method to perform the submuscular pocket. It may be applied to all procedures within the field of the breast augmentation, including reconstructive and esthetic surgery.