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Annals of Plastic Surgery Apr 2023Breast implants can be introduced through a variety of incisions, most commonly an inframammary incision, but also a periareolar incision or an axillary incision.... (Review)
Review
BACKGROUND
Breast implants can be introduced through a variety of incisions, most commonly an inframammary incision, but also a periareolar incision or an axillary incision. Usually, the implant is inserted through the same incision used in performing an augmentation/mastopexy. Some authors use a separate inframammary incision. Capsular contracture is the most common complication of breast augmentation. One theory holds that it is caused by an infected biofilm, prompting surgeons to minimize implant handling, known as the "no touch" technique. This review was undertaken to investigate the relationship, if any, between the access incision and the risk of capsular contracture.
METHODS
An electronic literature search was conducted to identify publications comparing capsular contracture rates by the access incision.
RESULTS
Ten studies were evaluated. Most were retrospective series. Three were prospective core studies. Some studies reported an increased risk of capsular contracture for a periareolar incision; a similar number did not. One study supported a separate inframammary incision at the time of vertical augmentation/mastopexy.
DISCUSSION
Bacterial studies in the last decade show that the resident bacteria on the skin surface and within breast tissue are similar. Sophisticated microbiological evaluation of breast capsules reveals that the microbiome relates to the patient, as opposed to a specific bacterial profile for capsular contracture. A review of the statistics used in determining an advantage for a separate incision at the time of vertical augmentation/mastopexy reveals that there is no statistically significant risk reduction when using an additional inframammary incision, which adds an unnecessary scar.
CONCLUSIONS
The access incision at the time of breast augmentation or augmentation/mastopexy is unlikely to affect the capsular contracture risk. There is no need to make a separate incision to insert the implant at the time of augmentation/mastopexy, or to isolate the implant from contact with breast parenchyma. Little evidence supports the "no touch" technique. The etiology of capsular contracture remains unknown.
Topics: Humans; Retrospective Studies; Prospective Studies; Mammaplasty; Breast Implantation; Breast Implants; Surgical Wound; Contracture; Implant Capsular Contracture
PubMed: 37093773
DOI: 10.1097/SAP.0000000000003437 -
Journal of Plastic, Reconstructive &... Nov 2022The use of perforator mapping has become routine for many microsurgeons in the planning and performing of free flaps in breast reconstructions. Within this field, the... (Review)
Review
BACKGROUND
The use of perforator mapping has become routine for many microsurgeons in the planning and performing of free flaps in breast reconstructions. Within this field, the number of available technologies and their quality has rapidly evolved over time. This study presents an up-to-date review on the spectrum of alternative perforator mapping modalities and the efficiency and utilization in the practice of free flap breast reconstructive surgery.
METHODS
Extensive searches of the PubMed and Embase databases were performed. Articles containing free flap tissue transfer in breast reconstruction and a perforator imaging modality were included. Qualitative and descriptive analyses of the outcomes were performed, and the quality of the evidence was appraised.
RESULTS
One hundred and sixty-eight articles were included. Besides the routinely used handheld Doppler, CT angiography, and MR angiography, seven alternative technologies (38 studies) have been found; color Doppler fluorescent angiography, dynamic infrared thermography, image-guided stereotaxy, template, 3D printed model, and augmented reality. The modalities were classified based on their concept of imaging as volumetric perforator imaging, real-time perforator imaging, and complementary techniques. A poor level of evidence for each alternative modality was found.
CONCLUSION
An overview of alternative imaging techniques available to pre- and intraoperatively map perforator locations have been given. Several novel promising techniques have been identified, all to be used in conjunction with volumetric imaging. This overview provides a perspective on the future field of imaging in reconstructive surgery.
Topics: Humans; Free Tissue Flaps; Mammaplasty; Plastic Surgery Procedures; Angiography; Computed Tomography Angiography; Ultrasonography, Doppler; Perforator Flap
PubMed: 36151036
DOI: 10.1016/j.bjps.2022.06.100 -
Ugeskrift For Laeger Jul 2018An increasing amount of evidence supports the benefits of fat grafting for breast augmentation, correction following breast-conserving surgery, breast reconstructions as... (Review)
Review
An increasing amount of evidence supports the benefits of fat grafting for breast augmentation, correction following breast-conserving surgery, breast reconstructions as well as correction of tuberous, hypoplastic and asymmetrical breasts. The aim of fat grafting is to create a breast with an aesthetic, natural appearance. In this review, we describe the most common indications for fat grafting of the breast and give an overview of the techniques in use as well as their associated risks and future perspectives.
Topics: Adipose Tissue; Breast; Breast Neoplasms; Female; Humans; Lipectomy; Lipodystrophy; Mammaplasty; Risk Factors; Stem Cell Transplantation; Tissue Expansion; Transplantation, Autologous
PubMed: 30064621
DOI: No ID Found -
Acta Clinica Croatica Sep 2022Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts....
Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts. This included breast augmentation, breast augmentation and lifting operations, in a ratio of 2 to 1.According to statistics from the American Association of Plastic Surgeons (ASPS), in 2020 breast augmentation with implants was ranked fifth of all cosmetic surgeries performedand the second largest body surgery immediately after liposuction, with 193,073 procedures done. In addition to these procedures, breast augmentation (87,051) and breast reduction (33,574) procedures were also popular. Due to the increased interestin these procedures and their high daily percentage of operating programs, adequate analgesia and recovery of patients, who undergo these cosmetic breast corrections, areimportant. Today, it is no longer enough for an operation to go well and the patients to have good results. It is also important that the procedure itself, from induction of anesthesia to early and late recovery, allows for a quick return to daily activities and work.
Topics: Humans; United States; Female; Ambulatory Surgical Procedures; Mammaplasty; Mastectomy; Analgesia; Breast Neoplasms
PubMed: 36824637
DOI: 10.20471/acc.2022.61.s2.06 -
Archives of Plastic Surgery Jan 2015Mammary implants marketed by Poly Implant Prothèse (PIP) were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity... (Review)
Review
Mammary implants marketed by Poly Implant Prothèse (PIP) were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Prothèse", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635) for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.
PubMed: 25606483
DOI: 10.5999/aps.2015.42.1.4 -
Aesthetic Plastic Surgery Jun 2018Although breast reduction surgery plays an invaluable role in the correction of macromastia, it almost always results in a breast lacking in upper pole fullness and/or...
AIM
Although breast reduction surgery plays an invaluable role in the correction of macromastia, it almost always results in a breast lacking in upper pole fullness and/or roundness. We present a technique of breast reduction combined with augmentation termed "reductive augmentation" to solve this problem. The technique is also extremely useful for correcting breast asymmetry, as well as revising significant pseudoptosis in the patient who has previously undergone breast augmentation with or without mastopexy.
METHODS
An evolution of techniques has been used to create a breast with more upper pole fullness and anterior projection in those patients desiring a more round, higher-profile appearance. Reductive augmentation is a one-stage procedure in which a breast augmentation is immediately followed by a modified superomedial pedicle breast reduction. Often, the excision of breast tissue is greater than would normally be performed with breast reduction alone.
RESULTS
Thirty-five patients underwent reductive augmentation, of which 12 were primary surgeries and 23 were revisions. There was an average tissue removal of 255 and 227 g, respectively, per breast for the primary and revision groups. Six of the reductive augmentations were performed for gross asymmetry. Fourteen patients had a previous mastopexy, and 3 patients had a previous breast reduction. The average follow-up was 26 months.
CONCLUSIONS
Reductive augmentation is an effective one-stage method for achieving a more round-appearing breast with upper pole fullness both in primary breast reduction candidates and in revisionary breast surgery. This technique can also be applied to those patients with significant asymmetry.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Adult; Breast; Cicatrix; Cohort Studies; Esthetics; Female; Follow-Up Studies; Humans; Hypertrophy; Mammaplasty; Middle Aged; Nipples; Patient Satisfaction; Retrospective Studies; Surgical Flaps; Suture Techniques; Treatment Outcome; Wound Healing
PubMed: 29124375
DOI: 10.1007/s00266-017-1010-0 -
International Journal of Environmental... Sep 2022In the last decade, there has been a noticeable increase in the interest in aesthetic and corrective surgery regardless of a patient's age. Both aesthetical and...
In the last decade, there has been a noticeable increase in the interest in aesthetic and corrective surgery regardless of a patient's age. Both aesthetical and practical considerations are a motivation for patients undergoing plastic surgery. The goal of this study is to analyze dependencies between welfare, self-assessment and body self-perception in patients that qualified for plastic and aesthetic surgical procedures. The study group included 164 female patients, of whom 124 patients filled out a questionnaire before and after surgery. The questionnaire included demographic data and scales such as the Body Esteem Scale, the Rosenberg Self-Esteem Scale-SES, the Satisfaction with Life Scale-SWLS, the Flourishing Scale and the Scale of Positive and Negative Experience-SPANE. The first hypothesis concerned the subjective assessment of body self-perception after the procedure. The results of the study confirm this hypothesis-female patients after surgery rate their body self-perception higher, which indicates a positive influence of plastic and aesthetic surgery that increased in the subjective assessment of 66 examined patients. Moreover, the study revealed a higher self-assessment after procedures. On the other hand, the results indicated that younger patients had a higher body assessment, but there was no increase in self-assessment. Except for breast augmentation surgery, there was no influence on self-assessment and life satisfaction improvement after other surgical procedures. In patients up to 48 years old, after surgery, there was a significant dependence between subjective body self-assessment and all surveyed forms of welfare. In the case of patients after 48 year of age, there was a relationship between life satisfaction and body self-perception both before and after surgical treatment.
Topics: Body Image; Esthetics; Female; Humans; Mammaplasty; Patient Satisfaction; Quality of Life; Self Concept; Self-Assessment; Surveys and Questionnaires
PubMed: 36141511
DOI: 10.3390/ijerph191811238 -
Plastic and Reconstructive Surgery.... Apr 2024Breast augmentation is one of the most commonly performed aesthetic surgery procedures. Yet, few reports in the literature analyze individual surgeon experiences with a...
BACKGROUND
Breast augmentation is one of the most commonly performed aesthetic surgery procedures. Yet, few reports in the literature analyze individual surgeon experiences with a unified surgical method on a large group of patients. This study aimed to analyze a single surgeon's complications rate and experience with the Akademikliniken augmentation mammaplasty method from the beginning of his career.
METHODS
A retrospective outcome analysis of all patients (n = 1646) who underwent breast augmentation between 2009 and 2021 performed by a single surgeon was conducted. Complications and reoperation rates were evaluated. In addition, correlations with the patient and implant characteristics and insertion-method-related risk factors were analyzed.
RESULTS
In total, 1212 female patients (mean age, 31.47 years) were analyzed. The minimal follow-up for every patient was 6 months (mean follow-up, 18.35 months). The total complication rate was 7.1%, and the most common complication (2.64%) was capsular contracture (Baker scale III/IV). Implant insertion with a funnel significantly lowered the overall risk of complications ( = 0.009). Statistical analysis indicates that the single independent risk factors for primary breast augmentation are patient age younger than 27 years, initial breast size B and C, and tobacco smoking.
CONCLUSIONS
This study indicated that capsular contracture and implant rotation are the most common complications of analyzed primary augmentation mammoplasty. It also identifies various risk and protection factors, such as funnel usage, which should be considered by the surgeon when performing this type of procedure.
PubMed: 38596589
DOI: 10.1097/GOX.0000000000005720 -
Cancer Control : Journal of the Moffitt... 2018Surgeons employ the latissimus dorsi flap (LDF) for reconstruction of a large variety of breast cancer surgery defects, including quadrantectomy, lumpectomy, modified... (Review)
Review
BACKGROUND
Surgeons employ the latissimus dorsi flap (LDF) for reconstruction of a large variety of breast cancer surgery defects, including quadrantectomy, lumpectomy, modified radical mastectomy, and others. The LDF may be used in delayed or immediate reconstruction, in combination with tissue expanders for a staged reconstruction, with implant-based immediate reconstruction, or alone as an autogenous flap.
METHODS
The authors discuss the historical uses and more recent developments in the LDF. More recent advancements, including the "scarless" approach and augmentation with the thoracodorsal artery perforator flap, are discussed.
RESULTS
The LDF is a reliable means for soft tissue coverage providing form and function during breast reconstruction with acceptable perioperative and long-term morbidities.
CONCLUSIONS
When there is a paucity of tissue, the LDF can provide tissue volume in autologous reconstruction, as well as a reliable vascular pedicle for implant-based reconstruction as in the setting of irradiated tissue.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Superficial Back Muscles; Surgical Flaps; Treatment Outcome
PubMed: 29334788
DOI: 10.1177/1073274817744638 -
Journal of Plastic, Reconstructive &... Nov 2021Transgender women and transfeminine spectrum nonbinary individuals may opt for breast augmentation. The aim of the study is to analyze the complications, surgical...
BACKGROUND
Transgender women and transfeminine spectrum nonbinary individuals may opt for breast augmentation. The aim of the study is to analyze the complications, surgical trends, and long-term follow-up of breast augmentations in this population over the past 30 years.
METHODS
All transgender women and nonbinary individuals who underwent breast augmentation at our center between 01-1990 and 01-2020 were retrospectively identified. A retrospective chart study was conducted, recording individual demographics, implant characteristics, surgical timing, postoperative complications or other reasons requiring reoperation, and implant survival. A literature search was performed in MEDLINE on clinical outcomes and revision surgery of this procedure.
RESULTS
A total of 527 individuals were identified. Median clinical follow-up time was 11.2 years (interquartile range 3.3-17.5). Median implant size increased significantly over the last years (1990-1990 median 275cc, 2000-2009 252cc, 2010-2019 375cc, p<0.01). Most individuals underwent breast augmentation and genital gender-affirming surgery in one-stage. Reoperations due to short-term complications were infrequent (hematoma (0.4%) or infection (0.4%)). Reoperations due to long-term complications comprised: implant rupture (5.7%), capsular contracture (4.9%), aesthetic problems (3.8%), low-grade infection (0.4%), or seroma (0.6%). In total, 2.5% of individuals requested larger implants. After performing the literature search and manuscript screening, 9 out of 115 identified studies were included for review. Follow-up time ranged from 30 days to 5.5 years. Reported complications requiring reoperation were capsular contraction (range 0.0-5.6%), asymmetry (3.6%), hematoma (range 0.0-2.9%), infection (range 0.0-0.9%) and implant rupture (0.7%), CONCLUSION: Implant-based breast augmentation is a safe procedure in transgender individuals.
Topics: Adult; Breast Implants; Female; Follow-Up Studies; Humans; Longitudinal Studies; Mammaplasty; Middle Aged; Netherlands; Retrospective Studies; Transgender Persons
PubMed: 34020905
DOI: 10.1016/j.bjps.2021.03.107