Ultrasound-Assisted Pocket Creation in Subglandular Breast Augmentation

Abstract Electrocautery remains the conventional technique for breast pocket dissection in augmentation, but it produces thermal injury, postoperative pain, and delayed recovery. Ultrasound-assisted liposuction devices may provide a less traumatic approach for subglandular breast augmentation. The aim of this study was to evaluate the safety, feasibility, and postoperative outcomes of real-time ultrasound-guided subglandular breast augmentation using ultrasonic dissection, hypothesizing that ultrasound-assisted dissection can be performed with minimum tissue trauma, postoperative pain, and recovery time. The authors conducted a prospective cohort including healthy women (aged 21-45 years) undergoing primary subglandular breast augmentation. All patients received real-time ultrasound-guided dissection using ultrasonic devices after tumescent infiltration. Outcomes included incision size, operative time, postoperative pain measured by visual analog scale (VAS), complications, and implant characteristics. The authors included 30 patients in the cohort. The mean age was 30 years (range, 22-45 years, standard deviation [SD] 4.9). The average implant volume was 278.5 cc (range, 205-375 cc, SD 38.9), with a mean incision size of 3.0 cm (SD ±0.34). The mean surgical time was 40.2 min (range, 24-55 min, SD 7.3). Pain intensity was minimal in the immediate postoperative period, with an average baseline VAS of 1.07 and a 24 h VAS of 1.7 (SD ±0.78). No patient reported the need for extra or stronger analgesic medication, nor did they declare having taken it. Image-guided ultrasonic subglandular dissection is technically feasible, safe, and well tolerated, with minimal pain, small incisions, and no major complications in short-term follow-up. This pilot study supports the concept of ultrasonic tissue separation in aesthetic breast surgery. Larger controlled studies with longer follow-up are needed to establish its role. Level of Evidence: 4 (Therapeutic)