by Raja Mohan, MD (@RajaMohanMD)
Within some plastic surgery circles, there is a palpable feeling of a dichotomy between aesthetic and reconstructive surgery, as though they are mutually exclusive. The case study and technique article in PRS Global Open titled, “Revision Breast Augmentation at the Time of Cardiac Sarcoma Resection: The Importance of Pocket Control When Inframammary Approach is Combined with Simultaneous Sternotomy,” disproves any notion that aesthetic and reconstructive surgery do not go hand-in-hand. They are both plastic surgery after all.
The authors should be commended for successfully performing breast augmentation in the setting of an oncologic case requiring a sternotomy. This case is definitely fraught with risks and is much less predictable than a standard breast augmentation. Like any ingenious plastic surgeon would, they devised an inframammary approach to place the implants that resulted in an outstanding outcome. The case highlighted the creativity in plastic surgery as well as the essence of breast augmentation.
A successful result in breast augmentation primarily relies on pocket control. My mentors have told me breast augmentation is essentially an exercise in pocket control. Any loss of control over the dimensions or borders of the pocket could potentially result in implant malposition. Many complications of breast augmentation such as double-bubble deformity and synmastia tend to fit into this category. In an unfamiliar situation, the authors of the article obtained control the pocket despite the loss of anatomic landmarks and structures. One of the important tenets is to always preserve natural anatomy but in cases where this is not possible, it is much more challenging to recreate natural anatomic structures. In the process of recreating the anatomy and developing a pocket from scratch for the implant, the authors also showed how implant position can be handled successfully.
In this example, a truly plastic surgery case combining elements of reconstruction and aesthetics provided lessons that can be used in a variety of settings. By learning how to recreate a pocket for a breast implant, we acquire details on reconstructing the inframammary fold or addressing synmastia. The authors also showed how bioprosthetics or acellular dermal matrices can be utilized in breast surgery to reinforce the pocket and help define the borders of the pocket. Although there are many original articles in the Plastic and Reconstructive Surgery Journal discussing how to manage implant malposition or the use of bioprosthetics in breast surgery, this case study combines these elements in a unique fashion. The lessons from this case are invaluable and have applications in both aesthetic and reconstructive surgeries. This case report exemplifies the elegance of plastic surgery. Regardless of the type of case, there are lessons to be learned that can be applied to any type of plastic surgery.
Revision Breast Augmentation at the Time of Cardiac Sarcoma Resection: The Importance of Pocket Control When Inframammary Approach Is Combined with Simultaneous Sternotomy. Rose, Jessica F. DO; Kim, Min P. MD; Reardon, Michael J. MD; Ellsworth, Warren A. IV MD, FACS. Plastic and Reconstructive Surgery – Global Open: March 2016 – Volume 4 – Issue 3 – p e647