Harvest of Rib Graft for Rhinoplasty in Breast Implant Patients

Overview

The paper asks whether a rib cartilage graft for the nose can be harvested safely during the same operation that places a breast implant. Four female patients, aged 19, 23, 24 and 27, had nasal reconstruction with a rib graft combined with breast augmentation or augmentation mastopexy between 2006 and 2016. All operations were done under one general anesthetic. The stated advantage is a single anesthesia and fewer days off work.

Sections of note

• Case series of four patients treated by the reported surgeon between 2006 and 2016.
• The rib graft was harvested first and the breast implant placed afterward, a sequence chosen to limit contamination.
• Access was through an inframammary incision, passing to the pectoral muscle fascia.
• After dissecting the perichondrium, a full thickness osteochondral graft was taken; sharp edges were rasped so they would not damage the silicone.
• Perichondrium and periosteum were sutured edge to edge to close the donor area.
• Harvested cartilage produced a spreader graft, a nasal valve graft, an onlay graft and an L-strut graft.
• No seroma, hematoma or infection occurred early; no rupture, leakage, capsule or deformity appeared over 2 to 10 years.

What it means for a patient

• Combining the two operations avoided a separate chest scar, because the breast incision gave access to the rib.
• Only four patients were reported, all by one surgeon, so the safety estimate is weak.
• There was no comparison group having the operations separately.
• The authors state the rib stumps must be covered with a thick protective layer to protect the implant.

Why this paper matters

Rib cartilage is a common graft source when septal cartilage is insufficient, and donor scarring is a routine objection. This report describes a way to hide that donor site inside a planned breast incision. Whether the combination raises infection risk across larger numbers remains untested.

Terms

• Rib graft: cartilage taken from a rib and reshaped to support or build up the nose.
• Perichondrium: the thin membrane covering cartilage.
• Spreader graft: a strip of cartilage placed alongside the septum to widen the internal breathing valve.
• L-strut graft: an L-shaped support that holds up the bridge and the base of the nose.
• Inframammary incision: a cut in the fold beneath the breast.
• Seroma: a collection of clear fluid under a healing wound.