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 A Pilot Study Evaluation of Three-Dimensional Imaging in Cosmetic Breast Augmentation: Results of a Single Surgeon 3.5 Year Retrospective Study Using the BREAST-Q Questionnaire

2021 ◽  
Author(s):  
Lauren E Hutchinson ◽  
Andrea D Castaldo ◽  
Cedar H Malone ◽  
Nicole Z Sommer ◽  
Ashley N Amalfi
Keyword(s):  
Patient Satisfaction ◽  
Breast Augmentation ◽  
3D Imaging ◽  
Breast Implant ◽  
Three Dimensional ◽  
Well Being ◽  
Three Dimensional Imaging ◽  
Size Selection ◽  
Implant Size ◽  
Implant Selection

Abstract Background Traditional methods of breast implant size selection provide limited ability to demonstrate postoperative outcomes. Three-dimensional imaging provides an opportunity for improved patient evaluation, surgical planning, and evaluation of postoperative breast appearance. Objectives We hypothesized that preoperative 3D imaging for patients undergoing breast augmentation would improve patient satisfaction and understanding of expected surgical outcomes. Methods A retrospective review of patients undergoing breast augmentation by a single surgeon over a 3.5-year period was performed. Patients presenting after the VECTRA was purchased had preoperative 3D imaging, while patients presenting before this did not. Eligible patients received a BREAST-Q questionnaire designed for postoperative evaluation of breast augmentation. They also received a second survey that evaluated expected versus actual breast outcomes. Results 120 surveys were mailed and 61 patients (50.8%) returned the survey. The 3D imaged group had improved BREAST-Q scores regarding satisfaction with outcome, surgeon, and physical well-being compared to the group that did not. The imaged group also had higher size, shape, and overall breast correlation scores, confidence in implant size selection scores, and communication with surgeon scores. The differences between the two groups were not statistically significant. Conclusions Three-dimensional imaging is a valuable tool in breast surgery. Although our study showed improvement in patient satisfaction and predicted outcome scores in the 3D imaged group, our results were not statistically significant. With the majority of patients reporting they would choose 3D imaging, it appears to instill confidence in patients regarding both surgeon and implant selection.

scholarly journals Five Year Safety and Satisfaction With the Lightweight Breast Implant

2021 ◽  
Author(s):  
Orel Govrin-Yehudain ◽  
Noam Calderon ◽  
Jacky Govrin-Yehudain
Keyword(s):  
Breast Implant ◽  
Capsular Contracture ◽  
Surgical Techniques ◽  
Silicone Implants ◽  
Form And Function ◽  
Kaplan Meier ◽  
And Performance ◽  
The Aesthetic ◽  
And Function ◽  
Surgeon Satisfaction

Abstract Background The B-Lite® lightweight breast implant (LWBI), weighs ~ 30% less than traditional silicone implants, while maintaining an equivalent size, form and function. The LWBI thus places less stress on breast tissues, preserves tissue stability and integrity over time, reducing weight-related complications and reoperation rates. Objectives To assess the long-term (over 5 year) safety and performance of the LWBI in primary and revision augmentation procedures. Methods Retrospective single-center, single surgeon analysis of prospectively collected data, was performed on 827 consecutive primary and revision augmentation patients operated between December 2013 and January 2019. 1653 implants (250-835 cc, mostly round, textured, extra high-profile) were implanted using standard surgical techniques. Direct physician-to-patient follow-up ranged from 6 to 67 months. Chart data on reoperations and overall complications as well as patient and surgeon satisfaction, were analyzed. Results The 5 year Per Patient Kaplan–Meier reoperation free rate was very high (97.1%). Only 2 out of 5 total cases of capsular contracture grade III required reoperation (KM rate 0.2%, CI- 0.1-1.0). No cases of rupture or BIA-ALCL were recorded. 94.9% of patients rated the aesthetic outcome, and 95.5% of patients rated the natural look and feel of their breasts, at 4-5 (Satisfied-Very Satisfied). Similarly, the surgeon rated 4-5 on 95.4% of the patients’ aesthetic outcomes. Conclusions The extremely favorable safety profile, high patient and surgeon satisfaction, and inherent benefits of reduced weight, in the largest known study of B-Lite® implant surgeries, should make the LWBI a strongly considered strategic alternative to traditional implants.

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.

Reoperative Transaxillary Approach Algorithm: Extending the Surgical Alternatives for Secondary Breast Augmentation in the Era of Scarless Surgery

2020 ◽  
Vol 40 (11) ◽  
pp. 1179-1192 ◽  
Author(s):  
Alexandre Mendonça Munhoz
Keyword(s):  
Breast Augmentation ◽  
Capsular Contracture ◽  
Surgical Techniques ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Transaxillary Approach ◽  
Scarless Surgery ◽  
Aesthetic Result ◽  
Axillary Incision ◽  
Grade Ii

Abstract Background Although the transaxillary approach (TAA) is useful in primary breast augmentation (BA) surgery, drawbacks of this technique include the need to correct complications arising from reuse of the axillary incision. Objectives The purpose of this study was to assess the outcomes of secondary BA procedures performed via the TAA in a cohort of patients operated on by a single surgeon and to provide an algorithm for reoperative TAA technique selection. Methods Sixty-two patients (122 breasts) underwent secondary TAA BA, which was indicated for capsular contracture (CC) in 35 patients (56.4%). Periods for analysis included less than 10 days, 1, 3, 6, and 12 months, and then at 2-year intervals postprocedure. Results Forty-three patients (69.3%) had a previous premuscular (PM) pocket; in 35 (81.3%) of these patients the new pocket was kept in the same position. Nineteen patients (30.7%) had a previous submuscular pocket, and 15 patients (78.9%) had the new pocket transferred to the PM plane. Ten cases of complications were observed in 8 patients (16.1%), Baker grade II/III CC in 3 (4.8%), and axillary banding in 2 (3.2%), during a mean follow-up of 72 months (range, 6-170 months). Fifty-nine patients (95.1%) were either very satisfied or satisfied with their aesthetic result. Conclusions Recent progress in surgical techniques has led to significant improvements in aesthetic outcomes following BA. The TAA can play a useful role in secondary BA cases and our results show this procedure to be useful, with acceptable complication rates, and the added bonus of avoiding additional scarring on the breast. Level of Evidence: 4

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.

Prevention of Capsular Contracture with Montelukast After Insertion of Silicone Implants in Rabbits

2016 ◽  
Vol 13 (10) ◽  
pp. 7623-7627
Author(s):  
Zhenyu Jin ◽  
Ki Yong Hong ◽  
Kyung Won Minn ◽  
Hak Chang ◽  
Ung Sik Jin
Keyword(s):  
Breast Implant ◽  
Capsular Contracture ◽  
White Female ◽  
Silicone Implants ◽  
Control Group ◽  
Tissue Samples ◽  
Significant Difference ◽  
Group A ◽  
The Right ◽  
Experimental Group

Capsular contracture is the most common complication after insertion of silicone implants during breast implant surgery. The discovery that myofibroblasts play an important role in the formation of hypertrophic scars led to the development of pharmacological drugs such as zafirlukast, which prevents capsular contracture by resisting the above mechanism. As a result, the author sought to investigate the effect of the anti-leukotriene montelukast on capsular contracture. Ten white female New Zealand rabbits, each weighing approximately 3 kg, were used as subjects. Through bilateral incision of the midback area, the prostheses were inserted on the subpanniculus carnosus plane. Once the silicone prostheses had been inserted, the right implant was injected with 10 mL of montelukast (10 µg/mL), and the left implant was injected with 10 mL of normal saline. Eight weeks after the procedure, the capsular pressure was measured via tonometry using a circular glass piece weighing 42.7 g. The tissue samples were then extracted, and their thicknesses were measured using hematoxylin-eosin stain and Masson trichrome stain. The average pressure was 4.23±0.99 mmHg in the control group and 3.71±0.51 mmHg in the experimental group, a statistically significant difference (p = 0.02). The average capsular thickness was 947.938±300 µm in the control group and 709.672±274 µm in the experimental group, a statistically significant difference (p = 0.028). The author confirmed that montelukast injections during silicone prosthesis insertion decreased the formation of capsular contracture.

scholarly journals Experimental model of capsular contracture in silicone implants

2003 ◽  
Vol 18 (spe) ◽  
pp. 22-28 ◽  
Author(s):  
Érika Malheiros Bastos ◽  
Miguel Sabino Neto ◽  
Lydia Masako Ferreira ◽  
Élvio Bueno Garcia ◽  
Richard Eloin Liebano ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Experimental Model ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Breast Implants ◽  
Silicone Implants ◽  
Frequent Complication

The breast implant procedure is one of the most performed into Plastic Surgery and the contracture that occurs the capsule formed around the breast implants one of most frequent complication. We describe here one experimental model of capsule contracture in rats.

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

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