Breast upper pole diaphragm (BUPD) release and retrofascial breast augmentation in chest malformation

Toma T Mugea
Oradea University, Romania

Breast upper pole (BUP) diaphragm represents the surgical keystone of the breast and pectoralis fascias anatomy, revealed by us after years of research and clinical intraoperative studies (more than 1,000 breast augmentations), which can’t be compared with cadaver dissections, even fresh ones.

Embryological breast mould start developing into superficial fascia invagination. As the suspensor ligaments and superficial fascia layers condense, these will become thin but very important anatomical structures, ligaments, connecting the superficial fascia to superficial layer of deep fascia as BUP diaphragm and inframammary crease ligament.

At the upper pole of the breast, near the second rib space, the pectoral fascia tightly connects with the superficial fascia of the breast and it is difficult to dissect bluntly. Here is the meeting point of three fascias that hang from the clavicle. The breast suspensor ligaments will be in continuity and will support the breast over the implant. Only the deep layer of the pectoralis fascia adheres to the clavicular periosteum, whereas its superficial layer continues with the superficial lamina of the deep cervical fascia, which surrounds the sternocleidomastoidian muscle.

Releasing this BUP diaphragm with a single horizontal incision, in the upper pole of the retrofascial plane of pectoralis muscle, the soft tissues will relax, allowing a spectacular enlargement of the pocket, with 2-3 cm on its vertical diameter. This is much more useful especially in cases with tight soft tissues and chest malformations, where the retropectoral implant position is not convenient. Significant clinical cases will demonstrate this.