Endoscopic Correction of Inferior Implant Malposition in Augmented Breasts with Electrocauterization

Breast augmentation surgery has been the most popular cosmetic surgery in the United States since 2006, accounting for 290,000 cases in 2013 [1]. Unfortunately, complications from the procedure can result in a reoperation rate approaching 15.5%. Complications after breast augmentation include capsular contracture, size change, malposition, waviness, deflation, infection, ruptured gel, palpability, and anxiety [2]. ‘Bottoming out’ is the term that describes an increase of the distance between the nipple areolar complex and the inframammary fold. In augmented breasts, inferior displacement of the breast implant beyond the inframammary fold can also be a causative factor. There are numerous procedures for correcting bottoming out, such as single or multilayer capsulorrhaphy, with or without mirror-image selective capsulotomy [3,4], capsulopexy [5], capsular flaps [6], polypropylene mesh, cadaveric dermis, and intracapsular allogenic dermal grafts [7-9]. However, these methods have drawbacks of larger incisions, longer surgical time, and possibility of infection caused by allogenic materials. Longer surgical time and costly allogenic materials can be sources of complaints and a burden for both the surgeon and the patient. In this case report, we propose a simple procedure for correcting an inferiorly malpositioned implant via an endoscopic approach.