Treatment of Inframammary Incision Opening After Breast Augmentation
For an opening inframammary incision after breast augmentation, immediate wound management with meticulous hemostasis and subcuticular closure technique is essential, with consideration for revision using a modified suture method that addresses all layers of the inframammary fold to prevent wound dehiscence and indented scarring.
Immediate Wound Management
Primary Closure Principles
- The skin should be closed with a subcuticular technique to optimize cosmetic results and minimize visible scarring 1
- Preservation of the subcutaneous tissue with separate closure improves the cosmetic outcome and structural integrity 2, 1
- Meticulous hemostasis is critically important to prevent hematoma formation, which can compromise wound healing and lead to further complications 2, 3
Layered Closure Approach
- A modified three-layer suture method addressing the inframammary fold anatomy significantly reduces wound-related adverse events (p = 0.026) and prevents indented scarring (p = 0.014) 4
- The modified suture method is the most influential factor in preventing inframammary fold-indented scarring (OR = 16.9), making it superior to traditional closure techniques 4
- Each anatomical layer of the inframammary fold must be properly approximated to restore structural integrity and prevent recurrent dehiscence 4
Risk Factors to Address
Patient-Specific Considerations
- Body mass index is a significant risk factor for wound complications (OR = 2.9), requiring more aggressive wound management in higher BMI patients 4
- Ensure adequate tissue perfusion and avoid tension on the closure, as excessive tension can lead to wound breakdown 2
Technical Pitfalls to Avoid
- Avoid excision of skin segments as this may alter the position of the inframammary crease and compromise healing 2, 1
- Do not reapproximate breast tissue in a way that appears adequate when the patient is supine but causes distortion when upright, as this creates tension on the incision 2, 1
- Prevent hematoma formation through meticulous hemostasis, as hematomas produce changes that complicate healing and may lead to infection 2, 3
Infection Prevention and Management
Surveillance for Infection
- Monitor for signs of infection, though infection rates are generally low (1.8-2.7%) with proper technique 5
- No statistically significant association exists between inframammary incision location and infection risk compared to other approaches 6
Antibiotic Considerations
- Consider prophylactic antibiotics if there are signs of contamination or delayed closure 6
- Early identification and treatment of infection is critical to prevent implant loss 5
Revision Strategy
Timing of Revision
- If primary closure is not feasible due to tissue loss or infection, allow for wound healing by secondary intention or delayed primary closure 4
- Plan definitive revision once the wound bed is healthy and free of infection 4
Surgical Technique for Revision
- Use the modified inframammary fold suture method with proper anatomical layer identification to reduce recurrence of wound complications 4
- Ensure the incision is of adequate size to allow proper visualization and closure without excessive tension 2, 1
- Consider minimal incision length techniques (when appropriate) to reduce scar burden, though this must not compromise proper closure 7