Use of a myringotome for percutaneous fasciotomies: a technical tip for assisting lipofilling.

Sir:

Although breast lipofilling is increasingly used in aesthetic and reconstructive surgery,[1] patients frequently develop fine, retracted adhesions in these areas, which can prevent expansion by fat graft. In these cases, especially for breast reconstruction, it can be difficult to inject large volumes during lipofilling, and complementary motions are required to prepare the recipient site. To improve results of the first injection, we propose the use of a myringotome, an instrument used to achieve paracentesis in ear, nose, and throat surgery (Fig. 1).[2] The myringotome is a disposable sterile instrument, with a narrow sharp blade at one end and a rigid handle at the other, allowing easy handling in different spaces. This instrument is very simple to use, efficient, and inexpensive.

Fig.1.

Myringotome with rigid handle and sharp blade.

CASE REPORT

We report the case of a 45-year-old woman with adherent scar after mastectomy and failure of immediate reconstruction. We performed this technique on the most serious scarred areas of the breast, with breast scars attached to the underlying chest wall (Fig. 2). The patient had a direct-to- implant reconstruction on single stage, with exposure of implant 2 weeks after surgery. At this time, she needed a removal and an antibiotic treatment, and she refused flap reconstruction. In the first stage, we suggested lipofilling initially to prepare the area before implementing an expander, considering the high risk of recurrence, material exposure, and cutaneous necrosis. The use of a myringotome by puncture incisions in the inframammary fold allowed subcutaneous adhesions quickly and efficiently. This technique allowed us to infiltrate about 150 mL into the breast from the deep to the superficial subcutaneous plane, whereas another technique would not have allowed such homogeneity and such a quantity. This procedure allowed a second stage with another fat graft and expander without complication.

Fig. 2.

A 45-year-old woman after mastectomy; puncture incision to release this retracted scar, adhering to the underlying chest wall.

DISCUSSION

Fat grafting is safe, reliable, and very useful. Sometimes, fasciotomies are necessary to give an excellent aesthetic result without deformity of the breast shape. Percutaneous fasciotomies are widely known and used with a 14- or 18-G trocar to release soft tissues set in tension by a double hook.[3,4] When realizing radial sections mainly in the inframammary fold or in the axillary process, the myringotome allows subcutaneous wide bays to prepare the ground for fat transfer into a healthy matrix.[3] These fasciotomies can release fibrous strings and deep adhesions especially on sequelae of conservative breast treatment or on tuberous breasts,[5] enhancing cosmetic results of lipomodelling and improving breast shape.[1] We realized some very short relaxing incisions, in contrast with percutaneous nicks that create areas with nonuniform reliefs.

CONCLUSION

In our experience, this technique could improve the rate of fat grafting and may diminish the number of surgical interventions required. The procedure should be considered as another tool in the plastic surgeon’s “arsenal” to assist in breast lipomodelling.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.