Long-term outcomes of two-stage, immediate and delayed breast reconstruction with polyurethane-covered versus textured implants: protocol of a prospective, multicentre randomised controlled trial (TIPI trial)

Internal Breast Lift: A New Method for Performing Internal Mastopexy

Background

Mastopexy combined with implant placement is a complex cosmetic surgery due to the dual nature of the procedure. Various mammoplasty techniques and implant types add to its intricacy. This study aimed to evaluate the effectiveness of an internal breast lift in correcting pseudoptosis, grade 1 breast ptosis, and asymmetries, thereby offering a safer alternative with reduced morbidity and avoiding the creation of an inverted T scar.

Methods

From January 2020 to January 2022, 20 female patients with pseudoptosis, grade I breast ptosis as per the Regnault classification, and a subareolar-to-mammary groove distance less than 7 cm were selected. For those with breast tissue hypertrophy, internal tissue resection maintained a minimum thickness of 3 cm. Patients with areolar asymmetries but without breast ptosis were also included. Surgical access was achieved via the mammary fold or periareolar approach. The procedure involved internal mastopexy between the mammary gland and the pectoralis major muscle's superomedial portion, coupled with polyurethane implant insertion.

Results

Significant elevations in the areola and breast tissue were noted in patients with pseudoptosis and grade I breast ptosis, with a notable pre- and postoperative difference (Student t test, P ≤ 0.050). Additionally, there was an improvement in areolar and breast tissue positioning in asymmetrical cases. Patient satisfaction and a 1-year follow-up were also part of the assessment.

Conclusions

The internal breast lift emerges as a safe and aesthetically pleasing alternative for patients with pseudoptosis and grade I breast ptosis. It effectively enhances areolar symmetry without the need for an inverted T scar.

SMI-Capsular Fibrosis and Biofilm Dynamics: Molecular Mechanisms, Clinical Implications, and Antimicrobial Approaches

Silicone mammary implants (SMIs) frequently result in capsular fibrosis, which is marked by the overproduction of fibrous tissue surrounding the implant. This review provides a detailed examination of the molecular and immunological mechanisms driving capsular fibrosis, focusing on the role of foreign body responses (FBRs) and microbial biofilm formation. We investigate how microbial adhesion to implant surfaces and biofilm development contribute to persistent inflammation and fibrotic responses. The review critically evaluates antimicrobial strategies, including preoperative antiseptic protocols and antimicrobial-impregnated materials, designed to mitigate infection and biofilm-related complications. Additionally, advancements in material science, such as surface modifications and antibiotic-impregnated meshes, are discussed for their potential to reduce capsular fibrosis and prevent contracture of the capsule. By integrating molecular insights with clinical applications, this review aims to elucidate the current understanding of SMI-related fibrotic responses and highlight knowledge gaps. The synthesis of these findings aims to guide future research directions of improved antimicrobial interventions and implant materials, ultimately advancing the management of capsular fibrosis and enhancing patient outcomes.

Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture

Capsular contracture is a common complication associated with breast implants following reconstructive or aesthetic surgery in which a tight or constricting scar tissue capsule forms around the implant, often distorting the breast shape and resulting in chronic pain. Capsulectomy (involving full removal of the capsule surrounding the implant) and capsulotomy (where the capsule is released and/or partly removed to create more space for the implant) are the most common surgical procedures used to treat capsular contracture. Various structural modifications of the implant device (including use of textured implants, submuscular placement of the implant, and the use of polyurethane-coated implants) and surgical strategies (including pre-operative skin washing and irrigation of the implant pocket with antibiotics) have been and/or are currently used to help reduce the incidence of capsular contracture. In this article, we review the pharmacological approaches-both commonly practiced in the clinic and experimental-reported in the scientific and clinical literature aimed at either preventing or treating capsular contracture, including (i) pre- and post-operative intravenous administration of drug substances, (ii) systemic (usually oral) administration of drugs before and after surgery, (iii) modification of the implant surface with grafted drug substances, (iv) irrigation of the implant or peri-implant tissue with drugs prior to implantation, and (v) incorporation of drugs into the implant shell or filler prior to surgery followed by drug release in situ after implantation.

Invited Discussion on: The Impact of Reconstructive Modality and Postoperative Complications on Decision Regret and Patient-Reported Outcomes following Breast Reconstruction

One in eight women will have a lifetime diagnosis of confirmed breast cancer, and one in three of these women will undergo a mastectomy. About half of women undergoing mastectomies will opt for some type of breast reconstruction. Breast cancer itself and breast reconstruction bring physical changes that are accompanied by psychological changes of varying degrees. The decision process about cancer treatment and whether or not to perform breast reconstruction brings suffering. In the case of choosing to perform the reconstruction, deciding when to perform it and which surgical technique to choose from among several available is quite complex, and may result in regret. The author provides a brief literature review on this subject and comments on the work carried out by Cai and Momeni, comparing data and results.Level of Evidence V 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.