Augmentation Mammoplasty

Definition

The insertion of an implant behind or under the breast tissue, to increase its size.

Discussion

• This procedure may be performed:

• 1. After a subcutaneous mastectomy.
  2. On a patient whose breasts are asymmetrical.
  3. For postpartum involution.
  4. For patient’s who’s smaller than desired (aesthetic).

• The approach may be inframammary, periareolar, or flatable, or filled with gel and saline.

Positioning

• Supine or modified Fowler’s

Packs/ Drapes

• Basic pack with transverse Lap sheet

Instrumentation

• Basic plastic tray
• Freeman areolar marker
• Basic procedure tray

Supplies/ Equipment

• Basin set
• Suction
• Fiberoptic headlight with light source
• Blades
• Needle counter
• Solutions
• Sutures
• Breast implant
• Surgical support bra

Procedure Overview

Inframammary Approach

1. The line of the incision is marked.
2. A 3-to-4-cm incision is made just above the inframammary crease.
3. A percutaneous is developed between the pectoralis fascia.
4. A plane is developed between the pectoralis fascia and the posterior capsule of the breast.
5. A pocket is created by blunt dissection to accommodate the implant.
6. Meticulous hemostasis is obtained, and the implant is inserted andadjusted as needed.
7. The subcutaneous flap is approximated, and the skin is closed in a manner preferred by the surgeon.

Periareolar Approach

1. The line of the incision is marked circumferentially.
2. The incision is made along the inferior border of the areola.
3. The subcutaneous tissue is dissected to the inferior border of the breast.
4. The retromammary space is enlarged by blunt dissection to accommodate the prosthesis.
5. Hemostasis is accomplished, and the prothesis is inserted.
6. The inferior border of the breast is sutured to the pectoralis fascia.
7. The incision is closed according to the surgeon’s preference.

Transaxillary Approach

1. The incision line is marked in the axilla.
2. A vertical or oblique incision is carried down through the subcutaneous tissue.
3. Using blunt dissection, a pocket over the upper poles of the sternum is created; hemostasis is achieved and the prosthesis is inserted.
4. The wound is closed in layers according to the surgeon’s preference.

Perioperative Nursing Considerations

1. Most implanted materials come sterile. However if they are not sterile, they should be washed first in a mild soap solution, dried carefully, and sterilized.
2. To avoid dust particles settling on the implant before use, cover it with a paper drape sheet.
3. Implants should be handled as little as possible and never with bare hands, since the oil from the handler’s skin could rub off onto the material.