Functional and Volumetric Analysis of the Pectoralis Major Muscle After Submuscular Breast Augmentation

BACKGROUND

Dual plane breast augmentation is a technical variation of the submuscular plane described as a technique that reduces contour deformities due to contraction of the pectoralis major muscle and lower risk of double-bubble deformity associated with breast ptosis. Despite improvement in the aesthetic aspect, there is still no consensus whether this technique affects the function of the pectoralis major muscle.

OBJECTIVES

The aim of this study was to correlate functional with volumetric changes associated with dissection of the muscle origin in submuscular breast augmentation.

METHODS

Thirty women who desired to undergo breast augmentation were selected prospectively and randomly allocated to 2 groups: 10 patients in the control group and 20 patients in the interventional group, who underwent submuscular breast augmentation. Magnetic resonance imaging and volumetric software were used to assess muscle volume and isokinetic dynamometry was used to assess function of the pectoralis major muscle. Preoperative measurements were compared with those at 3, 6, and 12 months after surgery.

RESULTS

Magnetic resonance imaging revealed significant decrease in muscle volume at 6 and 12 months follow-up. The isokinetic test conducted during adduction showed a significant difference in muscle strength between groups from baseline to the 12-month follow-up, and between the 3- and 12-month follow-up. No significant differences in muscle strength during abduction were observed from baseline to the 3-, 6-, and 12-month follow-up.

CONCLUSIONS

Submuscular breast augmentation reduced muscle strength during adduction 12 months after surgery, but without a significant correlation with volumetric muscle loss.

LEVEL OF EVIDENCE 2

Does intramuscular gluteal augmentation using implants affect sensitivity in the buttocks?

The evolution of techniques and materials has made gluteoplasty a safe and reproducible operation with high acceptance among surgeons and patients. Functional aspects should be considered in gluteoplasty but are poorly studied. The sensitivity of the buttocks is fundamental as it represents an erogenous zone and provides protection through sensory stimuli for the prevention of pressure sores and burns. This study aimed to evaluate the sensitivity of the gluteal region in patients undergoing gluteal augmentation with implants. We included 20 consecutive patients undergoing gluteoplasty and 20 controls not undergoing gluteal surgery. All patients are females and were being treated at the Division of Plastic Surgery of the Rio de Janeiro State University. The right and left gluteal regions were delimited, and each one was divided into four quadrants numbered 1-8. Sensitivity tests were performed in all quadrants for six different stimuli: touch, heat, cold, pain, vibration, and pressure. The mean age and BMI were 36.3 years and 26.3, respectively. No difference in sensitivity was observed in the gluteal region after augmentation gluteoplasty when compared with those patients who had no operation in this series. Prospective and controlled studies are needed to better assess these issues.

Profile of Patients Undergoing Gluteoplasty

BACKGROUND

Gluteal augmentation surgery has grown by 42 % per year; however, the epidemiological profile of patients who seek this treatment has never been studied.

OBJECTIVE

To establish the epidemiological profile of patients who have undergone gluteoplasty surgery, evaluating their level of satisfaction and the social impact caused by the surgery.

METHODS

Fifty patients, with ages ranging from 23 to 57 years replied to a specific questionnaire and the esthetic result of the surgery was evaluated. Thirty-seven patients were analyzed prospectively, using CT scans and gluteal reconstruction. The esthetic result was evaluated by eight plastic surgeon specialists from SBCP.

RESULTS

About satisfaction and quality of life, 98 % of the patients demonstrated improvement in some aspect of life. Analysis of the marital status of patients showed that 24 % of them have changed it. Therefore, all cases showed positive correlations between implant size and monthly income, age and satisfaction of patients. There has also been a positive correlation between implant size and recovery time. There was no statistically significant correlation between the esthetic result and the implant volume or the anthropometric measurements.

CONCLUSIONS

The epidemiological profile of patients undergoing gluteoplasty augmentation with implants is predominantly white skin, 36 years old, unrelated to the occupation or socioeconomic status. Augmentation gluteoplasty with implants is a surgery with a high level of satisfaction to patients, improving life in many aspects but, mainly, affectively. Its outcome produces a natural look and is hardly noticed by others.

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.

Evaluation of the effects of silicone implants on the breast parenchyma

BACKGROUND

Despite being the cosmetic procedure most performed worldwide, there are still few objective measurements of postoperative volumetric analysis of breast augmentation available in the literature.

OBJECTIVE

The aim of this study was to evaluate volumetric changes in the breast parenchyma after the placement of silicone implants in the subglandular plane.

METHODS

Thirty-four women were randomly allocated to the intervention group (n = 24), who underwent breast augmentation in the subglandular plane, or to the control group (n = 10), who received no intervention. Volumetric magnetic resonance imaging was performed at inclusion, and after 6 and 12 months in all participants. The non-parametric Friedman's test was used for statistical analysis.

RESULTS

There was a significant reduction in glandular volume (mean, 22%) at 12 months postoperatively in patients who underwent breast augmentation.

CONCLUSIONS

Breast augmentation caused reduction in the volume of the breast parenchyma.

LEVEL OF EVIDENCE

3 Therapeutic.

Mammaplasty utilizing the periareolar approach

An analysis of 300 cases of reduction mammaplasty done utilizing a periareolar approach at the University Hospital of the State of Rio de Janeiro and our own private clinic during the period from September 1989 through October 1995 is presented in this article. The technical evolution of this procedure is described in detail as well as how the complications were eliminated and the aesthetic results improved. A thorough analysis of recommendations and comments on the results are made by the authors.

Massive breast hypertrophy in a young girl

A patient with massive virginal breast hypertrophy is reported in this study. A 16-year-old girl presented with abnormal growth of her breasts in 1 year. Due to the enormous breast volume, which caused her physical and psychological problems, she curtailed her social life. After a thorough gynecological and breast assessment, she was referred to the plastic surgery division for breast reduction. She underwent total subcutaneous mastectomy followed by immediate breast reconstruction by subpectoral prosthesis implantation.

Convergent nipple-areolar complexes corrected by inferior curved pedicle technique

We report a case of mammaplasty followed by a marked convergence of the nipple-areolar complex and describe the surgical repair by means of an inferior dermal-fat curved flap. The curve of the inferior pedicle permits one to raise the nipple to its normal position with ease and exceptional viability, even if a breast reduction procedure is associated.

T abdominoplasty to remove multiple scars from the abdomen

A patient presented with multiple scars on the abdomen from previous surgical procedures. Much of the scarring was eliminated and the form of the abdomen restored by an atypical inverted T abdominoplasty.

Extensive cervical and lower face lipectomy: its importance and anatomical basis

The authors propose a more extensive lipectomy than usual along and above the mandibular branch, to obtain better results in the neck and lower face in rhytidectomy. The operative technique is based on anatomical findings. Results are excellent when the procedure is indicated and properly performed. Lipectomy is recommended in patients with abnormal fat deposits about the lower face and neck; it is not advised for obese patients.