Summary
Background
Techniques based on three planes of implant placement, including the subglandular
(SG), subpectoral (SP), and subfascial (SF) planes are used for breast augmentation.
The placement that offers the greatest balance of risks and benefits is unclear. This
study presents a systematic review with a Bayesian network meta-analysis to compare
different implant placement techniques for augmentation mammaplasty.
Methods
A systematic literature search was performed. We estimated the odds ratios (ORs) for
capsular contractures, hematomas, seromas, infections, reoperation rates, rippling,
nipple numbness, malplacements, ruptures, and asymmetry among the different interventions.
Muscle movement events and satisfaction rates were also evaluated.
Results
A total of 19 studies (25,744 cases) were included. SG placement significantly increased
the incidence of capsular contractures (SP vs. SG: OR 0.42; 95% credible interval
[CrI] 0.28–0.63; SF vs. SG: OR 0.41; 95% CrI 0.17–0.97), hematomas (SF vs. SG: OR
0.22; 95% CrI 0.06–0.63), and seromas (SF vs. SG: OR 0.04; 95% CrI 0.00–0.81) compared
to other placement techniques. Muscle movement only occurred in the SP group, but
it did not increase the risk of subsequent malplacements, asymmetries, or ruptures.
Most patients were highly satisfied with their surgical results. Comparisons did not
show significant differences in the remaining results.
Conclusions
Our evidence suggests that SG placement increases the risk of capsular contractures,
hematomas, and seromas. The SP and SF planes were safe and effective for controlling
total complication rates and achieving high satisfaction rates; however, the long-term
benefits of the SF technique require further research.
Keywords
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Article info
Publication history
Published online: September 24, 2019
Accepted:
September 9,
2019
Received:
April 3,
2019
Identification
Copyright
© 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
