Reoperative Augmentation Mammoplasty: An Algorithm to Optimize Soft-Tissue Support, Pocket Control, and Smooth Implant Stability with Composite Reverse Inferior Muscle Sling (CRIMS) and its Technical Variations

Reoperative hybrid breast augmentation: An analysis of risk factors for complications and reoperations

BACKGROUND

Autogenous fat grafting (AFG) has become a common procedure to optimize aesthetic results in breast augmentation (BA). However, complications or outcomes in reoperative BA remain unclear. This study compared the outcomes or risk factors in reoperative BA with AFG and without AFG.

OBJECTIVES

To assess outcomes from AFG in a large series of patients undergoing reoperative BA.

METHODS

We identified a retrospective cohort of patients who underwent secondary BA, and then established 2 groups that did and did not receive AFG. Charts were reviewed for complications or reoperations. The primary outcome was complications (identified clinically or via imaging), and regression logistic analysis was used to evaluate risk factors including age, body mass index, smoking, implant surface/volume, and previous pocket.

RESULTS

Overall, 293 patients were included (age: 41 ±9.4 years, follow-up: 70.4±30.7 months). In the AFG group (n = 111), 27.9% had at least 1 complication, most frequently capsular contracture; 12% had a previous submuscular pocket (43% presented animation deformities). In the non-AFG group (n = 182), 29.6% had at least 1 complication. No significant difference was observed between groups for total complications (p = 0.750) or reoperation (p = 0.665). AFG itself was independently associated with increased risk of altered imaging results (p = 0.002; OR = 2.92), predominantly oil cysts. In the AFG group, animation was completely resolved.

CONCLUSIONS

Despite extensive AFG research, previous reoperative BA studies are limited and have not analyzed complications or long-term outcomes. AFG provides adequate tissue thickness to allow for a more superficial pocket, thus resolving animation issues. Our results indicate that AFG is a reliable technique that permits satisfactory outcomes and does not increase overall complication or reoperation rates compared to the procedures without AFG.

Outcome analysis and assessment of the lower pole expansion following breast augmentation with ergonomic implants: Optimizing results with patient selection based on 5-year data

BACKGROUND

Silicone implants have gone through adaptations to improve esthetic outcomes. With the progress of technology, including gel rheology, different properties have been introduced. Ergonomic style implants (ESI) feature enhanced rheological properties and provide a shaped contour with a round base.

OBJECTIVES

This study investigated outcomes for ESI in breast augmentation concerning lower pole stretching (LPS) and implant stability and describes an algorithm to assist in decision-making.

METHODS

A total of 148 patients (296 breasts) underwent breast augmentation with ESI; this procedure was indicated in patients with good skin quality and <6 cm between the nipple-areola complex and the inframammary fold.

RESULTS

The mean patient age was 29.6 years (range: 19-39), and 93 patients (62.8%) underwent primary breast augmentation with demi/full projection (average volume of 245 cc [175-375 cc]). Axillary incision and subfascial pocket were indicated in 115 (77.7%) and 72 (48%) cases, respectively. Average LPS values were 32.2% (24.91 mm) and 10.86% (9.42 mm) at up to 10 days and 10 days to 12 months postprocedure, respectively. Patients were followed for a mean of 29.9 ± 26.4 months (range: 6-66). Complication rates per breast and per patient were 5% and 10%, respectively, and included subcutaneous banding in the axilla (1.6%), implant displacement (1.2%), and wound dehiscence (0.8%). No cases of infection, seroma, or rippling complications were observed.

CONCLUSIONS

The present decision-making algorithm summarizes the process involved in breast augmentation using ESI and is intended to help standardize decisions. With correct planning, long-lasting outcomes can be achieved due to favorable interactions between ESI and the patient's tissues.

Impact on capsule formation for three different types of implant surface tomography

Although capsular contracture remains one of the major problems following silicone breast implantation, the associated mechanism has yet to be determined. This study thus aimed to investigate capsule formation and capsular contracture using three types of implants with different surface topographies in vivo. Three types of implants (i.e., smooth, macrotexture, and nanotexture) with different surface topographies were inserted in a total of 48 Wistar rats. After 4 and 12 weeks, the samples were analyzed via histological, immunohistochemical, and Western blot examination. To identify implant movement, the degree to which implant position changed was measured. And the surface topography was characterized using scanning electron microscopy. Hematoxylin–eosin staining showed that the nanotexture type implant promoted significant decreases in capsule thickness at 12 weeks (P < 0.05), while Masson trichrome staining showed decreased collagen fiber density with the same implant type. Immunohistochemical and Western blot examination revealed reduced fibrosis markers (myofibroblast, and transforming growth factor beta-1) in the nanotexture surface implant. Meanwhile, implant location evaluation found that the nanotexture and smooth surface implants had significantly increased movement (P < 0.05). The nanotexture surface implant had been found to reduce capsule formation given that it minimizes the effects of factors related to foreign body reaction.