PURPOSE: This is a retrospective review of the technique and outcomes of transabdominal breast augmentation (TABA) through a single abdominoplasty incision. The senior author has performed a large number of these procedures in the past six years in an outpatient setting almost exclusively under monitored anesthesia care (MAC). Few studies have been published regarding transabdominal breast augmentation and these are often limited by short term follow up and small case series. In addition, the majority of these surgeons utilized general anesthesia. We hypothesize that those patients who desire abdominoplasty often request accompanying breast augmentation and that the combined procedure is a favorable approach in terms of minimizing incisions and can be safely performed without general anesthesia, thereby limiting post op nausea and vomiting. In addition concerns about inframammary fold violation and capsule contracture complications from a blunt dissection technique were investigated for validity.

METHOD: The charts of all patients who underwent TABA from 2002 to 2008 were reviewed. Demographic data, co-morbidities, operative duration, additional procedures, type of anesthesia, type and size of implant, postoperative complications, revisions, and long-term results were reviewed. TABA was offered to all patients requesting simultaneous abdominoplasty and bilateral breast augmentation with minimal ptosis (grade 0-1 ptosis/pseudoptosis).  Smoking cessation was required at least four weeks prior to surgery and indefinitely post procedure.  Surgery was performed on an outpatient basis under MAC in conjunction with intercostal nerve blocks. A traditional abdominoplasty via a low transverse incision was performed followed by creation of subcutaneous tunnels across the inframammary fold. Following either subglandular or preferably subpectoral pocket creation, either saline or silicone implants were placed. The tunnels at the IMF were closed using interrupted permanent suture. After midline plication, drains were placed and the abdominal incision was closed using absorbable suture.

RESULTS: Forty-eight female patients were identified who underwent TABA from 2002 to 2008.  Postoperative follow up ranged from less than 1 month to 66 months, (average 13.6 months, not including 2008 patients) and age ranged from 22 to 55 (average 40.6 years). Operation times ranged from 1:20 to 6:15, with longer duration being associated with multiple additional procedures. General surgery was used in four cases, secondary to location (main hospital OR) and concomitant procedures (1 gynecologic procedure).  Thirty two patients had multiple procedures in addition to TABA, with the majority (n=21) having additional suction assisted lipectomy.  Three patients had subglandular implants, with the remainder being subpectorally placed. Silicone implants were placed in fourteen patients.  Implant size ranged from 150cc to 500cc.  Complications included minor wound complications (n=9), seroma drained in the office (n=2), post op methicillin sensitive staph aureus infection treated with oral antibiotics (n=1) and implant malposition requiring operative IMF revision (n=1).  Symptomatic capsule contracture higher than Baker 2 (n=2) was not seen in any patient.  Of note, two patients who had wound complications were heavy smokers (>1 pack per day) that had quit smoking pre-operatively but resumed post-operatively against recommendations.
CONCLUSION: It is our experience with this large case series that TABA, in the properly selected patient, is an excellent choice for patients requesting both abdominoplasty and breast augmentation.  In our series, we primarily utilized MAC with intercostal nerve blocks which were tolerated well.  Symptomatic capsular contraction rate was absent.  In addition, complications were minimal with most revisions being undertaken while undergoing further cosmetic procedures.  There are distinct advantages to the use of this technique, which include complete lack of breast incisional scarring, elimination of implant trauma during placement and lack of symptomatic capsular contracture sequelae.  The results of this study confirm this procedure as a valuable asset to the rejuvenative esthetic plastic surgeon’s armamentarium.