Prospective Study of Saline versus Silicone Gel Implants for Subpectoral Breast Augmentation

Anatomical Considerations for Hyaluronic Acid Filler Injection for Breast Augmentation in Young Female Patients

BACKGROUND

Hyaluronic acid (HA) fillers offer a minimally invasive alternative for breast augmentation, appealing to young female patients seeking natural results and minimal recovery time. However, achieving optimal outcomes requires a thorough understanding of breast anatomy, filler properties, and safe injection techniques. This study provides a comprehensive analysis of the anatomical considerations, techniques, and filler properties necessary for optimal breast augmentation using HA filler. It also explores patient selection, long-term safety and efficacy, and the management of complications. A review of key anatomical structures, including glandular tissue, fascial layers, vascular anatomy, and Cooper's ligaments was conducted. Injection techniques, such as dual-plane and submuscular approaches, were analysed with a focus on pre-procedural imaging. Four cases of young female patients undergoing breast augmentation using HA filler (e.p.t.q. eve X, Jetema Inc., Seoul, Republic of Korea) were analysed. The efficacy of HA fillers in achieving natural breast enhancement was demonstrated in all four cases. Ultrasound played a crucial role in ensuring accurate filler placement, reducing risks like vascular occlusion and filler migration. Patients reported high satisfaction and minimal complications, though periodic treatments were required for maintenance. HA filler-based breast augmentation is a safe and effective option for young female patients, delivering natural results with rapid recovery. Although the results can be temporary and maintenance treatment is required, HA fillers may offer a non-invasive alternative to silicone implants. Optimal outcomes can be achieved through a thorough understanding of anatomy, the use of highly cohesive fillers, and ultrasound-guided injection techniques.

Capsular Contracture After Breast Augmentation: A Systematic Review and Meta-Analysis

Capsular contracture is characterized by the formation of a fibrous capsule around a breast implant after an augmentation mammaplasty, and often results in pain, firmness, and implant distortion. The aim of this meta-analysis was to investigate how implant and surgical characteristics affect rates of capsular contracture after breast augmentation. A systematic review and meta-analysis were performed in PubMed MEDLINE, EMBASE (OvidSP), and Cochrane Library. Comparison groups included smooth vs textured implants; subpectoral vs prepectoral implant placement; saline vs silicone implants. Odds ratios (ORs) were calculated for capsular contracture for each of these groups. The inclusion criteria were met in 24 studies. Smooth implants were associated with significantly higher capsular contracture rates compared with textured implants (OR = 2.80, 95% CI, 1.92-4.08). Subpectoral implant placement demonstrated significantly reduced capsular contracture rates compared with prepectoral placement (OR = 0.35, 95% CI, 0.25-0.50). No significant difference in capsular contracture rates was found between silicone and saline (OR = 0.39, 95% CI, 0.02-6.69). This meta-analysis suggests that textured-surface implants are associated with lower capsular contracture rates than smooth implants following breast augmentation. Additionally, subpectoral implant placement was associated with significantly reduced rates of capsular contracture compared with prepectoral placement. There was no significant difference in capsular contracture rates between saline and silicone implants. However, the absence of large, randomized controlled trials included in this study underscores the need for prospective investigation of the relationship between implant and surgical characteristics and postoperative outcomes.

Level of Evidence 2 Risk

Breast Implant Illness as a Clinical Entity: A Systematic Review of the Literature

BACKGROUND

Breast implant illness (BII) has become a contentious subject in recent years. Although some studies have reported associations between breast implants and autoimmune diseases, others have failed to establish a definitive link.

OBJECTIVES

The objective of this study was to provide a comprehensive, up-to-date evaluation of the literature surrounding BII, with an emphasis on identifying patient-related factors that may be associated with BII.

METHODS

A systematic review was performed following PRISMA guidelines by searching the PubMed (MEDLINE), Embase, and Cochrane databases for relevant studies published in the last 20 years.

RESULTS

Thirty-one studies were included, which covered 39,505 implant patients with a mean [standard deviation] age of 44.2 [9.30] years. Fifteen studies reported implant explantation status, with 72.4% patients choosing to remove their implants. Among these, 9 studies reported symptom improvement in 83.5% patients. Fifty-three percent of patients undergoing explantation had total capsulectomy. Twenty-eight studies documented total numbers of patients experiencing symptoms related to BII, with 31.3% patients reporting such symptoms. Among these, 16 studies of 4109 BII patients distinguished whether the reason for implantation was cosmetic augmentation or reconstruction. When specified, more patients experiencing BII-related symptoms received implants for "cosmetic" vs "reconstructive" reasons (cosmetic, 3864/4109 [94.0%] vs reconstruction, 245/4109 [5.96%]; P < .001).

CONCLUSIONS

This review provides an overview of the current state of knowledge regarding BII. The study highlights a potential relationship between BII and indication for implants (cosmetic vs reconstructive) among other variables, offering valuable insight on factors associated with BII and directions for future research.

LEVEL OF EVIDENCE: 3

A Case Report on Breast Implant Illness

In this case report, we discuss the case of a 64-year-old woman who presented with an unusual complaint of a chronic cough associated with pleuritic chest pain of 15 years following a saline-filled breast implant surgery. Initially, these were minimally abated by acid reflux medications. However, her cough worsened despite other interventions. In the work-up to determine the etiology of her complaints, the most common causes of a chronic cough were considered. The history ruled out post-nasal drip, and pulmonary function tests excluded asthma and chronic obstructive pulmonary disease (COPD), although she had a family history. An IgE allergy panel and an Aspergillus antibody test were also normal. However, an esophagram revealed a significant finding of mild to moderate Gastroesophageal reflux disease (GERD). Ultimately, the subsequent removal of the implants led to a dramatic resolution of her symptoms. It is worth noting that breast implants, like any other medical device, carry certain risks. Complications such as infections, implant rupture, capsular contracture, and changes in breast sensations are known risks associated with breast augmentation surgery.

Does Overfilling Smooth Inflatable Saline-Filled Breast Implants Decrease the Deflation Rate? Experience with 4761 Augmentation Mammaplasty Patients

BACKGROUND

Research suggests that overfilling saline inflatable breast implants may decrease their deflation rates. To date, there has been no large-scale study comparing breast implants filled within vs. beyond the manufacturer's recommended fill volumes.

METHODS

A retrospective comparative study was conducted for 4761 women who underwent aesthetic augmentation mammaplasty by the author. Patients were divided into two groups: Group 1 includes 2960 patients who had breast augmentation between 2002 and 2009 with implants filled within the manufacturer's recommended fill volumes. Group 2 includes 1801 patients who had breast augmentation between 2011 and 2018. Their implants were overfilled with an average volume between 42 and 50 cc, or 10-13%, respectively. All surgeries were performed with Mentor Style 1600 saline breast implants (smooth, round moderate profile) through an inframammary incision; implants were placed in the subpectoral (dual) plane. Also evaluated was the yearly increase in deflation rates.

RESULTS

Group I had 119 deflations, representing a deflation rate of 4.02%. Group 2 had 33 deflations, providing a deflation rate of 1.83%. The author found a protective effect in overfilling the device (p < 0.00001 and Z-score of 4.17). Fold failure was the major reason for deflation in both groups. The implants filled within the manufacturer's recommended volume had a yearly increase in deflation rate of 0.41%, not 1% as is commonly reported. The overfilled implants did not have a yearly increase in deflation rate.

CONCLUSION

Overfilling Mentor Style 1600 saline breast implants (smooth, round moderate profile) 10-13% significantly reduced the deflation rate.

LEVEL OF EVIDENCE III

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 .