Augmentation Mastopexy With Surgical Excision of the Lower Pole to Avoid Waterfall Deformity: A Surgical Technique and Nipple Areolar Complex Case Series

2020 ◽  
pp. 229255032093366
Author(s):  
Colin P. White ◽  
Brian D. Peterson
Keyword(s):  
Surgical Technique ◽  
Breast Augmentation ◽  
Capsular Contracture ◽  
Case Series ◽  
Senior Author ◽  
Complex Case ◽  
Silicone Implants ◽  
Lower Pole ◽  
Areolar Complex ◽  
Augmentation Mastopexy

Purpose of this article is to demonstrate a way of avoiding the waterfall deformity in augmentation mastopexy patients. We will show a case series of results and explain how this technique gives satisfying aesthetic results for patients seeking breast augmentation who also require mastopexy. We will show how addressing the breast parenchyma on the lower pole via direct excision can give reliable results and avoids the waterfall deformity. The surgical technique used by the senior author combines the principles of breast augmentation, mastopexy, and breast reduction. We apply these principles during the initial single operation. Our goal is to achieve the best anatomical results for the patient. We describe 1538 consecutive patients whom underwent single-stage breast augmentation with mastopexy. All implants were submuscular with 12% being saline and 88% were silicone implants. Vertical mastopexies were performed in 8% and wise pattern incisions were used in 92%. There were no life-threatening complications such as deep vein thrombosis, pulmonary embolism, and so on. Tissue-related complications included wound infection (1%) and hematomas (1%). Implant-related complications included malposition or implant displacement 9% and capsular contracture 1%. Aesthetic complications included dystopia of NAC (4%) and volume asymmetries (10%). Revision surgery was tissue related (2%), implant related (3%), and aesthetic related (10%). There were no cases of waterfall deformity seen in the cohort. In conclusion, we believe that the technique detailed here is easy to do, uses principles already known of breast augmentation and reduction and gives consistent results with low reoperation rates.

Periareolar Augmentation-Mastopexy

2019 ◽  
Vol 39 (9) ◽  
pp. 953-965 ◽  
Author(s):  
Ryan E Austin ◽  
Maryam Saheb-Al-Zamani ◽  
Frank Lista ◽  
Jamil Ahmad
Keyword(s):  
Surgical Technique ◽  
Breast Augmentation ◽  
Perioperative Management ◽  
Single Stage ◽  
Breast Size ◽  
Lower Pole ◽  
Excess Skin ◽  
The Common ◽  
Periareolar Mastopexy ◽  
Augmentation Mastopexy

AbstractThe authors describe their surgical technique for single-stage periareolar mastopexy with subglandular breast augmentation. They have performed this procedure in 85 patients since 2009 and found that this operative technique has allowed them to achieve reproducible outcomes in a single-stage procedure. Periareolar mastopexy with subglandular breast augmentation is an excellent procedure for patients who desire a larger breast size and who present with mild to moderate nipple ptosis with a paucity of excess skin in the lower pole of the breast. This article will review the perioperative management and detailed steps of the procedure and outline its indications for utilization and some of the common complications the authors have encountered.

Breast Augmentation

2019 ◽  
Author(s):  
Eric J. Culbertson ◽  
William P. Adams Jr
Keyword(s):  
Breast Augmentation ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Three Dimensional ◽  
Surgical Techniques ◽  
Postoperative Recovery ◽  
Silicone Implants ◽  
Aesthetic Result ◽  
Incision Location ◽  
Implant Selection

Breast augmentation is a complicated process that goes far beyond placing an implant in a pocket. The implants and techniques of breast augmentation have undergone significant evolution over the past 50 years, and this is now one of the most commonly performed cosmetic procedures worldwide. Advancements in shell barrier technology and silicone form stability have improved implant functional characteristics and mechanical properties. Tissue-based planning uses measurable patient characteristics to match an implant to the patient’s tissue for greater control of the aesthetic result while minimizing complications. The realization of three-dimensional modeling systems allows a more sophisticated approach to implant selection and establishment of patient expectations. Specific surgical techniques, including pocket plane and incision location, ensure ideal implant placement. Optimal patient outcomes are achieved by integrating patient education, implant selection with tissue-based planning, refined surgical technique, and detailed postoperative recovery.  This review contains 12 figures, 6 tables, 1 video, and 74 references. Key Words: breast augmentation, breast implants, breast implant-associated anaplastic large cell lymphoma, dual plane, capsular contracture, saline implants, silicone implants, tissue-based planning, three-dimensional imaging 

scholarly journals Does Implant Surface Texture Affect the Risk of Capsular Contracture in Subglandular Breast Augmentation and Breast Augmentation-Mastopexy?

2019 ◽  
Vol 40 (5) ◽  
pp. 499-512 ◽  
Author(s):  
Frank Lista ◽  
Ryan E Austin ◽  
Maryam Saheb-Al-Zamani ◽  
Jamil Ahmad
Keyword(s):  
Breast Augmentation ◽  
Bacterial Contamination ◽  
Capsular Contracture ◽  
Surgical Techniques ◽  
Breast Implants ◽  
Textured Surface ◽  
Implant Surface ◽  
Silicone Gel ◽  
Increased Risk ◽  
Augmentation Mastopexy

Abstract Background Previous studies have reported decreased rates of capsular contracture associated with the use of textured surface breast implants placed in the subglandular plane during breast augmentation. However, since the publication of these studies, our understanding of the pathophysiology of capsular contracture, as well as the surgical techniques utilized to minimize bacterial contamination of the implant, have advanced considerably. Objectives The purpose of this study was to re-evaluate the relation between implant surface texturization and capsular contracture rates for breast implants placed in the subglandular plane during primary breast augmentation. Methods Retrospective chart review was performed of all primary subglandular breast augmentation procedures involving the use of either smooth or textured round silicone gel implants, with or without simultaneous mastopexy. The primary outcome measures included clinically significant capsular contracture (Baker grade III/IV) and revision surgery for capsular contracture. Results Between 2010 and 2017, 526 patients underwent primary subglandular breast augmentation with either smooth (n = 212) or textured (n = 314) round silicone gel implants; 248 patients underwent breast augmentation, whereas 278 underwent breast augmentation-mastopexy. Average follow-up was 756 days in the textured group and 461 days in the smooth group. Five cases of capsular contracture were observed in the textured group, and 7 cases of capsular contracture were observed in the smooth group (P = 0.20). Conclusions Smooth surface implants placed in the subglandular plane were not at a significantly increased risk of capsular contracture compared with textured surface implants. We suggest that adherence to a surgical technique focused on minimizing bacterial contamination of the implant is of greater clinical significance than implant surface characteristics when discussing capsular contracture. Level of Evidence: 4

Case Report of Spontaneous Hemorrhage 13 Years After Breast Augmentation

2020 ◽  
Vol 37 (4) ◽  
pp. 163-167
Author(s):  
Pierre S. Gordon ◽  
Mark Mandell-Brown
Keyword(s):  
Breast Augmentation ◽  
Capsular Contracture ◽  
Adhesion Formation ◽  
Late Complications ◽  
Skin Closure ◽  
Early Complications ◽  
Spontaneous Bleeding ◽  
Class 1 ◽  
Augmentation Mastopexy ◽  
Pocket Hematoma

The case of a delayed spontaneous bleed 13 years after an augmentation mastopexy is presented. The patient underwent exploration of the breast pocket, hematoma evacuation, implant extraction, vessel ligation, and skin closure without immediate reimplantation. Early complications of breast augmentation include hematomas in 1% to 10% of cases. Late complications include capsular contracture, implant deflation, implant rupture, and rarely delayed bleeds. There are various theories regarding the pathophysiology of late hematomas to include erosion of pericapsular arteries, capsular microfractures, and chronic inflammation. Theories regarding the pathogenesis of capsular contracture are discussed using literary evidence that highlights an association between capsular contracture and capsular bleeding. Evidence discussed includes recurrent bleeds, progression from class 1 to class 4 Baker Contractures, and bilateral capsules with thicker capsules on the side having bleeding. Similar processes seen in other specialties like adhesion formation after gynecologic procedures are seen. In conclusion, delayed spontaneous bleeding after breast augmentation is rare, imaging and prompt exploration should follow, and consideration should be given to capsulectomy.

scholarly journals Breast implant rupture 37 years after breast augmentation

2021 ◽  
pp. 69-69
Author(s):  
Marko Jovic ◽  
Ivan Radosavljevic ◽  
Jovan Mihaljevic ◽  
Jelena Jeremic ◽  
Milan Jovanovic
Keyword(s):  
Breast Augmentation ◽  
First Generation ◽  
Histopathological Examination ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Surrounding Tissue ◽  
Silicone Implants ◽  
Complication Rates ◽  
Macroscopic Appearance ◽  
Implant Rupture

Introduction Silicone implants have been used ever since the second half of the 20th century. Over that period several generations of implants have been developed that differed in thickness of the shell and viscosity of the silicone gel. Development of these generations of implants was accompanied with different complication rates. The first-generation implants had the lowest tendency to rupture, but were more prone to capsular contracture and calcification formation. Case outline An 81-year-old female patient had her silicone implants placed in 1983. After a chest injury in 2015. on the lateral aspect of the left breast a tumefaction becomes palpable and she complains of pain. She denies any subjective problems before the injury. After pertinent diagnostic procedures and clinical examination, silicone implant rupture was suspected. Surgical findings confirmed ruptures of both implants so that they were extracted, capsulectomy was performed and the surrounding tissue imbibed with silicone removed. Samples were sent for histopathological examination. Conclusion Implant rupture is one of late complications of breast augmentation. The incidence of ruptures has changed with development of newer generations of silicone implants. We believe that our patient had the first-generation silicone implants, knowing the time from their placement to the occurrence of symptoms and macroscopic appearance of the shell after extraction. The fact is that these implants have proved to be very durable, but regardless of the lack of symptoms, current guidelines recommend regular screening for rupture, while possible preventive extraction, particularly in case of so old implants should be considered.

scholarly journals Breast augmentation with silicone implants performed without drainage - retrospective analysis of 726 cases

2017 ◽  
Vol 74 (2) ◽  
pp. 152-155
Author(s):  
Nenad Stepic ◽  
Jovana Koncar ◽  
Milica Rajovic ◽  
Sanja Novakovic ◽  
Marijan Novakovic
Keyword(s):  
Retrospective Analysis ◽  
Breast Augmentation ◽  
Capsular Contracture ◽  
Surgical Techniques ◽  
Early Postoperative Period ◽  
Silicone Implants ◽  
Wound Drainage ◽  
Dual Plane ◽  
Significant Difference ◽  
Plane Technique

Introduction: Breast augmentation has been one of the most popular aesthetic procedures. Early complications, like infection, seroma, hematoma and capsular contracture like one of the most frequent long term complication, might be related to wound drainage. Aim of the study was to investigate the rate of the complications of breast augmentation procedure performed without drainage. Material and Methods. Retrospective analysis of all patients underwent breast augmentation in the period of 2003-2013 was performed. From the medical history of the patients, data related to demographic characteristics of the patients, surgical technique and rate of complications were collected. Wound drainage has not been used in any of the patients. Patients were followed at the discharge, after 7 days, three months and yearly thereafter. Wound seroma, wound hemathoma, wound infection and capsular contracture were followed. Results. There were 726 patients with average age of 28,5 year (22-48). Breast augmentation using silicone implants was performed with inframammary approach using subglandular, submuscular and dual plane technique. Average implant size was 339cc (200-520). Subglandular augmentation had 545 (75%), while, 181 (25%) received an implant in submuscular plane. Those, who were operated with dual plane technique were 86 (47,5%).In early postoperative period, there was no infection, five seromas (0,7 %) and eight hematoma (1,1%), while five of them required surgical evacuation. There was no statistical significant difference between the two surgical techniques in terms of complication rate. During follow up, there were three capsular contractures (0,4%). Conclusions. The incidence of complications in our group of patients after breast augmentation is low even though no drainage was used. Still, further randomized trials are needed to prove role of drainage in prevention of complications after breast augmentation.

scholarly journals Aspecte morfopatologice si strategii de preventie a contracturii capsulare după augmentarea mamara cu implante

2021 ◽  
Vol 17 (2) ◽  
pp. 91-98
Author(s):  
Nadia Aladari ◽  
Mihaela Perțea ◽  
Camelia Tamas ◽  
Iulia Dabija Olaru ◽  
Madalina Palaghia ◽  
...  
Keyword(s):  
Breast Augmentation ◽  
Capsular Contracture ◽  
Breast Implants ◽  
Silicone Implants ◽  
Textured Surface ◽  
Number Of Factors ◽  
Antibiotic Solution ◽  
History Of ◽  
Inflammatory Drugs ◽  
After Cancer

Breast augmentation with silicone implants is one of the most common procedures performed by plastic surgeons around the world. Capsular contracture is one of the complication in breast augmentation that requires invasive reparation surgery. The inflammatory response to the breast implants appears to be directly associated with capsular contracture. In addition to the type of material (saline vs. silicone) used and it’s texture (smooth vs. textured), a number of factors were detected related to their position and the existence of a history of radiotherapy after cancer treatment for breast cancer. It tries to identify ideal methods to prevent and minimize the risk of developing capsular contracture. Among the methods currently used were described: placement of the implant in the retropectoral plane, dissection of a larger pocket, performing a rigorous hemostasis, use of implants with textured surface, minimizing the exposure time, contact and handling of the implant, irrigation of the pocket with antiseptic solutions (5% betadine) or broad-spectrum antibiotic solution to prevent the infectious process, the use of talc-free gloves, the use of corticosteroids, immuno-modulators and anti-inflammatory drugs.

scholarly journals Does the Use of Intraoperative Breast Sizers Increase Complication Rates in Primary Breast Augmentation? A Retrospective Analysis of 416 Consecutive Cases in a Single Institution

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Lee Seng Khoo ◽  
Henrique N. Radwanski ◽  
Vasco Senna-Fernandes ◽  
Nsingi Nsosolo Antônio ◽  
Leonardo Luiz Fernandes Fellet ◽  
...  
Keyword(s):  
Complication Rate ◽  
Breast Augmentation ◽  
Capsular Contracture ◽  
Planning System ◽  
Silicone Implants ◽  
Complication Rates ◽  
Single Institution ◽  
Training Tool ◽  
Significant Difference ◽  
Novice Surgeon

Background. Is the use of intraoperative breast sizers beneficial for plastic surgeons or do they result in higher complication rates? Methods. This is a retrospective study of 416 consecutive cases of primary breast augmentation with silicone implants at the Plastic Surgery Service of Professor Ivo Pitanguy at the 38th Infirmary Santa Casa Misericórdia Hospital, Rio De Janeiro, from January 2011 to March 2014. 212 cases (51%) were carried out with use of intraoperative breast sizers with 204 cases (49%) without the use of implant sizers. This study compares the outcome of cases that employed the use of intraoperative implant sizers versus those that did not in terms of infection, hematoma/seroma formation, and capsular contracture. Results. Of 416 primary breast augmentation cases, there were 5 cases of infection (1.2%), 4 cases of seroma (1%), 3 cases of hematoma (0.7%), and 7 cases of capsular contracture (Baker’s Grade III/IV)(1.7%). Total complication rate limited to infection, seroma, hematoma, and capsular contracture was 1.15% (95% CI 0.96–1.93%). There was a significant difference in the scores for breast sizers (M = 4.3, SD = 1.4) and no breast sizers (M = 2.3, SD = 0.87) conditions, t(8) = 2.79, p=0.018. The use of implant sizers was correlated with a higher complication rate. Conclusion. Good results could be obtained without the use of breast sizers in primary breast augmentation with use of a biodimensional tissue based planning system while eliminating risks of infection and reducing intraoperative time. Notwithstanding, in a residency program breast sizers can be an excellent training tool to shorten the learning curve in the novice surgeon.

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