Dr.med.univ. Peter Lisborg
PKLP Ästhetik – Zentrum für ästhetische Chirurgie
Feldkirchnerstraße 217, A-9020 Klagenfurt – Austria
peter.lisborg(at)drlisborg.at

 

Achieving good optical results for breast augmentation is possible with almost any technique using various implants. But in many cases the implants are palpable and present major problems. Addressing a low grade nipple ptosis is a further challenge.

The author will present an anatomical concept avoiding vessel damage, protecting the implants with a complete muscular-fascial covering and a simple concept to correct low grade nipple ptosis.

In sedation, tumescent anaesthesia (0,1%) is applied subpectorally and subcutaneously. The periareolar incision is made a) intra-areolar for non-ptotic nipples or b) supra-areolar for ptotic nipples (Crescent-Nipple-Lift). Parenchyma is divided straight to the pectoral muscle. Usually on the fifth rib a slit between fibres of the pectoral muscle is made and a pocket created between ribs and the chest muscle complex. In this manner, vessels which enter the muscle complex from the medial and lateral intercostal zones are preserved. It is seldom necessary to perform e-cautery in the pocket. Muscle and parenchyma are sutured. Nipple ptosis can then be corrected by suturing the areola upwards where a crescent form of tissue was resected.

In 15 years of augmentation surgery there was not a single case of postoperative bleeding. In case of infection the implants could be maintained. Almost cases of nipple ptosis (low–middle grade) could successfully be treated with this procedure. Limiting factors were too much abundant skin from the nipple to the inframammary fold or too small implants. Exact consultation regarding further ptosis correction is necessary.

Total Submuscular Augmentation is a reliable and safe technique for breast augmentation. Crescent nipple lift can is often a good alternative to other procedures with less scarring.