vias_acceso Access points

 

In this image we can see the different access roads to the cavity where the prosthesis will lodge and after the intervention.

They are the following:

AXILLARY APPROACH
It is one of the favorites in our clinic, as it has many advantages:
  • Scar scarcely visible and far from the breast, in the axillary hollow, coinciding with an armpit fold
  • – The mammary gland is not touched, so the sensitivity of the nipple is not altered
  • Does not interfere with breastfeeding
  • There are no scars left in the breast tissue, which allows a better control of the breast to rule out tumor pathology.
  • Having a blunt dissection and a more anatomical plane there is less incidence of hemorrhage and hematoma.
  • The prosthesis is placed in a little vascularized space that exists behind the pectoral muscle (retropectoral situation).
  • In our experience we have had very few complications, less than in the other routes used.
Disadvantages:
  • It is a closed technique, so it is more complex than others in which there is a direct approach; the result depends a lot on the skill and experience of the surgeon in that technique.
  • Complications, if they occur, are more difficult to solve than when using other routes; in some cases, it may be necessary to practice a different approach.
It is the route of choice in cases of:
  • Patients who do not want scars on their breasts
  • Small size Areolas
  • Family history of mammary tumors or patients with fibrocystic breasts who must follow radiological controls often.
AREOLAR APPROACH

It can be hemiareolar (only the lower 1/2 of the circumference of the areola) or periareolar (scar on the entire circumference of the areola).

 

The hemiareolar incision leaves a scar less apparent than the complete periareolar, and also maintains the tone gradient that usually exists in the skin of the areolas. It can be used when the position of the areola-nipple complex (ANC) is correct, that is, it should not be raised.

The complete periareolar incision is used when there is a decrease in the CAP because the breast is slightly drooping, being possible to raise it approximately 2 cm.

The areolar route can be used to place the prosthesis in any location of those explained above.

Advantage:
  • It allows a central access in the pocket that will lodge the prosthesis and serves for any plane of placement of the same.
It is the route of choice in the following cases:
  1. When you have to descend the inferior breast groove (breasts with very high furrow)
  2. When you have to associate a mastopexy
  3. In tubular or tuberous breasts
INFRAMMAMARY APPROACH

It was the first to be used and was replaced first by the areolar and then by the axillary, to avoid some of its complications.

 

Advantages:
  • There is no limitation regarding the length of the incision.
  • Approach quite direct, although less than the areolar approach.
  • The breast is not touched, so it does not interfere with breastfeeding or mammary controls.
  • allows to use any type of implant.
Disadvantages:
  • Scars visible in the area of ​​the submammary furrow
  • Worst covering tissue of the prosthesis at the groove level; the prosthesis is very close to the scar, practically underneath, and there is the risk, at least, of extruding it due to decubitus.

It is our route of choice when the patient already has this scar, or when the patient prefers it to the other routes for a specific reason.

After reading this information, it can be understood how the choice of the access route and the subsequent situation of the prosthesis varies depending on the characteristics of each case; We believe that all techniques should be known and mastered in order to offer the patient the best and most suitable for her.

The third issue to decide is the type of prosthesis, since there are also advantages and disadvantages in this.

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