Smooth Implant Stability in Inframammary Approach Augmentation: The Modified Bi-Muscular Flap Technique VS. Dual-Plane with Fixation Suture

Amid the global trend toward smooth implants' use, implant stability has become a progressively significant concern for augmentation mammaplasty. During the dual-plane augmentation via the inframammary fold (IMF) approach, IMF fixation suture-suturing the Scarpa's fascia to the deep fascia-is routinely adopted by surgeons to minimize inferior implant displacement. However, this approach of maintaining implant stability demonstrates inconsistent reliability, particularly with smooth implants. Excluding suboptimal technical factors, the fundamental cause of implant malposition lies in inadequate inferior or lateral support structure. Based on pectoralis major's anatomical foundation and the access characteristics of the IMF incision, the authors introduce an innovative technical refinement-the modified bi-muscular flap (BMF) technique. The procedure involves an L-shaped muscle release that preserves the lateral long-head origins of the muscle, creating an inferior support structure for the implant. A preliminary outcome compared with the dual-plane technique using fixation suture suggests that this new technique may represent a promising alternative for reducing smooth implant malposition and improving long-term stability.