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21.08.2018 | Original Article | Ausgabe 6/2018

Aesthetic Plastic Surgery 6/2018

The Use of a Retromammary Adipofascial Flap in Breast Augmentation for Patients with Thin Soft Tissue

Aesthetic Plastic Surgery > Ausgabe 6/2018
Hyun Ho Han, Kenneth K. Kim, Kee Hoon Lee, In-Beom Kim, Paik Kwon Lee
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00266-018-1215-x) contains supplementary material, which is available to authorized users.
This method in breast augmentation has been presented at the 2015 Korean Society of Plastic and Reconstructive Surgery Meeting in Seoul (13 Nov, 2015).



In patients with a thin soft tissue breast envelope, lower pole implant palpability is a postoperative sequela that concerns patients. Anatomically, the lower aspect of the breast near the inframammary fold lacks sufficient soft tissue to cover the breast implant after augmentation.


A transareolar incision was made, and subcutaneous dissection was performed. The dissection first proceeded caudally to the lower aspect to the breast parenchyma. The dissection then changed direction and moved cephalad to the mid breast or nipple region. The fatty tissue and pectoralis muscle fascia were cut transversely at this level, and the dissection was reversed caudally in a subfascial plane to the new inframammary fold region. This maneuver created a retromammary adipofascial flap.


A total of 368 breast augmentations were performed in 184 patients. Breast implants were inserted in the subfascial plane in 40 patients (21.7%) and in the subpectoral–subfascial plane in 144 patients (78.3%). A total of 368 breast implants were inserted, including 140 smooth cohesive silicone implants (38.0%), 2 textured round implants (0.5%), and 226 anatomic-type implants (61.5%). A cadaveric dissection revealed that a retromammary adipofascial flap measuring 3–4 mm in thickness can be acquired. Capsular contracture occurred in six breasts (1.7%).


During breast augmentation, an inferiorly based retromammary adipofascial flap can be created to help cover the lower pole of the breast from implant palpability. This is helpful especially in patients with thin skin, hypoplastic breasts, or constricted breasts.

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.

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