PURPOSE:
This is a retrospective review of the technique and outcomes of transabdominal breast augmentation (TABA) through an abdominoplasty incision. The senior author has performed a large number of these procedures in the past six years in an outpatient setting primarily under monitored anesthesia care (MAC). Few studies have been published regarding transabdominal breast augmentation and these are limited by short-term follow-up, small case series and the majority of these surgeons utilized general anesthesia. We hypothesize that patients who desire abdominoplasty often request accompanying breast augmentation. The combined procedure minimizes incisions and can be safely performed under MAC. Also, concerns about inframammary fold violation and capsule contracture complications from a blunt dissection technique were investigated for validity.

METHODS:
The charts of 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, and long-term results were reviewed. TABA was offered to patients requesting simultaneous abdominoplasty and breast augmentation with minimal ptosis. 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. 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, saline or silicone implants were placed and the IMF tunnels 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) and age ranged from 22 to 55 (average 40.6 years). Operation times ranged from 1:20 to 6:15, longer duration was associated with multiple additional procedures. General anesthesia was used in four cases, secondary to location (main hospital OR) and concomitant procedures (1 gynecologic). Thirty two patients had multiple procedures in addition to TABA, the majority (n=21) had additional suction assisted lipectomy. Three patients had subglandular implants, the remainder were 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 MSSA 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:
In our series, we primarily utilized MAC with intercostal nerve blocks which were tolerated well. Symptomatic capsular contraction was absent. 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.