PEER-REVIEW | BODY CONTOURING |
particular diets to define and lose a lot of subcutaneous fat). However, the immediate postoperative course is slightly more painful.
Deltoid
This triangular muscle attaches proximally at the external third of the clavicle, the acromion and the scapular spine. The fibres of this muscle are responsible for the roundness of the shoulder and join together distally at the deltoid V, where they are attached to the humerus shaft. Its innervation depends on the axillary nerve, which enters the deltoid posteriorly after leaving the quadrilateral space. The surgeon should approach the muscle from its
anterior side. The incision is made at the anterior edge of the deltoid V, at the groove between the deltoid and biceps. The incision is deepened to the bone and a pocket is made by blunt dissection. The pocket has to be wide enough to accommodate the implant. For this location, a smooth, oval implant can be used,
and the author prefers a volume of 110 cc (Figure 8). This implant has a similar shape to the muscle and the tip of the implant will be under the deltoid V. No drains are used. The muscle fibres are sutured with 2-0 Vicryl and the incision is closed. The primary potential problem with this muscle is
implant displacement. The space is tight, the floor of the pocket is convex, and the implant might be unstable with the movements of the arms. The author has performed three cases of deltoid
implants to date (six implants in total). The volume of the implants was 100 cc in all cases. In one of the patients, one of the implants displaced and required surgical repositioning and reinforcement of the anterior wall of the pocket with a mesh.
Triceps The triceps has three heads, namely the long, medial and lateral heads, that converge distally forming a tendon that inserts into the olecranon. The radial nerve groove is closely related to the muscle, so extreme care is needed to avoid injuring it. The incision may be made at any of the sides of the
medial contour and one Glicenstein implant, 90 cc, for lateral contour
Group III: six patients, all male. Two of them had only medial enhancement with one implant (submuscular in both cases). The other four patients had two implants in each limb, submuscular in two patients and subfascial in the remaining two.
Results are very good with both subfascial (Figure 6) as
submuscular (Figure 7) techniques. However, the author believes that the result is much more natural with submuscular placement and the edges of the implants cannot be seen (especially in those patients who follow
36 July/August 2014 |
prime-journal.com
Figure 8 Deltoid augmentation, 110 cc oval (A) and (B) before treatment; and ) C) and (D) after treatment. The new contour is seen with the arm adducted, and remains natural when abducted, without unduly and obvious convexity
triceps tendon, and the dissection is deepened under the tendon and muscle. A careful blunt dissection is performed under the long head of the triceps and is expanded medially and laterally. Blunt dissection avoids inadvertent rupture of any nerve branch crossing the muscle. It is recommended that no muscle relaxants be used by the anaesthesiologist so that the surgeon is able to check any muscular movement in the vicinity of the radial nerve. In most cases, the author uses oval buttock implants, 110–240 cc, depending on the available pocket (Figures 9 and 10). In some cases, where there are atrophied or very thin muscles, it is best to use Montellano implants (Figure 11). The author has performed four cases to date. One case
was a 26-year-old patient with a left brachial plexus injury as a result of a traffic accident. He had radial and circumflex palsies. A 140 cc Glicenstein implant was
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