Reconstruction of the Submammary Crease for Correction of Postoperative Deformities in Aesthetic and Reconstructive Breast Surgery
by Hamid Massiha, MD, F.A.C.S.
From the Louisiana State University Medical Center, New Orleans,
LA.
Received Sep 19, 2000, and in revised form Oct 11, 2000. Accepted
for publication Oct 11. 2000.
The submammary crease is a very important landmark with regard to
aesthetics of the female breast. In asymmetry of the breast after
augmentation mammaplasty, it may be necessary to reconstruct a new
crease to correct asymmetry and any resulting deformity. Also, in
reconstructive breast surgery, having a reliable means of reconstructing
a crease anywhere that is appropriate would be a great asset in the
surgeon’s armamentarium. For example, an expander can be used to
expand tissues of the lower chest somewhat below the ideal submammary
crease. At the time of placement of a permanent implant, the submammary
crease can be reconstructed in the desired location.
Technically, the desired site of the crease is marked preoperatively
with the patient in a sitting position (Figs lA, B). During surgery,
after removal of the implant or the expander, the crease is created
by suturing the anterior capsular tissue to the posterior part
of the capsule at the anterior chest wall. Nonabsorbable
sutures are
used after implant insertion. The patient then is placed in a semisitting
position. If correction is not adequate, sutures are placed in
a more proper location. I have used this technique in the
last 20 years
with good, long-lasting results. The submammary crease, and its
continuation laterally and medially, is the most important
determining factor
in beauty and contour of the female breast. Irregularities in this
area of anatomy are detected easily by simple observation. Asymmetry
after breast augmentation is frequent (Fig lC), not only in the
submammary crease, but frequently at the lateral boundaries
of the mammary pocket
and less frequently at the medial aspect. At times we have seen
cases that have transgressed the midline, creating a severe
deformity.
In any and all of these kinds of deformities, this method of correction
works well (Fig lD).
Patients and Methods
The patient is
marked carefully in a sitting position (see Figs lA, B). The patient
is then anesthetized (I use general anesthesia
in my practice), and proper prepping and draping are completed. Entry
is made into the breast capsule area using previous incisions. The
implant is removed and the capsule is evaluated. The capsule is then
incised and the pocket is expanded. The capsule is then deeply sutured
to the chest wall at the appropriate site