Preoperative planning and breast implant selection for volume difference management in asymmetrical breasts

Aim: To assess volume management in patients presenting with breast asymmetry and ptosis. Methods: Retrospectively collected data was analysed. The patients were divided into 3 groups. Group A included patients who had volumetric difference alone and had different size implants alone. Group B included patients who had volumetric difference with breast ptosis requiring mastopexy with different size implants. Group C included patients who presented with breast asymmetry with ptosis and had same size implants on both sides with different volume breast reduction. Results: Subgroup A1 included 145 patients who had larger implants placed on right side. Subgroup A2 included 95 patients who had larger implants on the left side. Subgroup B1 included 7 patients who had larger implants on the right. Subgroup B2 included 13 patients who had larger implant on the left side. Subgroup C1 included 7 patients who had larger reduction on right side. Subgroup C2 included 11 patients who had larger reduction on left. Conclusion: When different volume implants are used, the vast majority of the patients do not require a volume difference of more than 60 mL. When the breast is larger on the right then larger mean volumes are used on left side to offset the larger right breast.

Augmentation mastopexy and augmentation mammoplasty:an analysis of 1,406 consecutive cases

Aim:Simultaneous augmentation mastopexy is a challenging operation for esthetic plastic surgeons.Complication and revision rates following augmentation mammoplasty or mastopexy are less commonly seen when these two procedures are performed separately.However,when the two procedures are combined,the complication rate is reported exponentially higher when compared with its individual component carried out separately.The current retrospective chart review is a comparative analysis of the two procedures performed by a single surgeon.Methods:Retrospective data were collected using patient’s charts.All patients who had augmentation mammoplasty(Group A)or simultaneous augmentation with mastopexy(Group B)in muscle splitting biplane using round cohesive gel textured silicone implants by a single surgeon were included.Results:A total of 1,406 patients had consecutive augmentation mammoplasty or simultaneous augmentation mastopexy.Augmentation mammoplasty(Group A)included 1,298 and simultaneous augmentation with mastopexy(Group B)had 108 patients,respectively.The mean age of the patients in Group A and B was 29.6 years and 32.2 years,respectively(P=0.006).The mean size of the implants in Group A and B was 340 mL and 308 mL(P=0.001),respectively.Wound infection in Group A and B was seen in 0.6%and 3.7%,respectively.Wound breakdown was seen in 1.1%in Group A as compared to 6.5%in Group B(P=0.001).Revision surgeries were performed in 1.4%and 11.1%of Group A and B,respectively(P=0.001).Conclusion:There was a statistically and clinically significant higher rate of complications and revision rate noted in simultaneous augmentation with mastopexy(Group B)as compared to augmentation mammoplasty alone(Group A).However,the rise in complications rate is sum of the complications of the two individual components performed and not exponential.

One-stage mastopexy and augmentation mammoplasty in layers: outcome analysis of first 50 consecutive cases

Aim: The single-stage procedure is a challenging procedure for Plastic Surgeons. The single-stage layered mastopexy with augmentation is a new technique that is aiming to add safety, preserving breast function and to restore normal parameters of breast. Methods: A retrospective chart review of 50 consecutive cases of layered mastopexy with augmentation mammoplasties was performed. All patients had their implants placed in muscle splitting pocket. Incisions for mastopexy were selected on the basis of nipple areolar complex to inframammary crease. Mastopexy is performed using a medially based pedicle, leaving a sufficient tissue covering the implant. Patients were divided into three groups. Group 'A' who had periareolar mastopexy, Group 'B' had vertical scar mastopexy and Group 'C' patients had mastopexy with Wise pattern markings. Results: Group A comprised 11 patients. The mean age was 28.82± 7.01 years, mean preoperative and postoperative nipple areolar complex (NAC) to IMC measurement was recorded in 10 patients with the mean of 7.15± 1.98 cm and 8.35± 1.18 cm respectively. Mean size of the implant used was 379.55± 77.18 cm3. Group B comprised 29 patients. Mean age was 35.17± 12.37 years and the mean preoperative and postoperative NAC to IMC crease was 8.53± 1.48 cm and 9.72± 1.51 cm respectively. The mean implant size used was 289.48± 109 cm3. Group C had 10 patients. Mean age was 39.60± 12.15 years and the mean preoperative and postoperative NAC to IMC crease of 10.11± 1.24 cm and 8.75± 0.98 cm respectively. The mean implant size used was 287.00± 55.08 cm3. Conclusion: The procedure allows better arterial supply, wider area for venous and lymphatic drainage, better sensory innervation to NAC and maximises lactation potential of the breast.

Pathogenesis,presentation and classification of late autoinflation of the breasts:case report and literature search

Aim:Autoinflation of the breast following mammoplasty using breast implants can be divided into early and late.Early autoinflation of the breast is commonly due to haematoma.Late autoinflation of the breast is an uncommon complication and its true incidence is not known due to the paucity of its reporting.Methods:A retrospective review was performed of the available charts for 2,772 consecutive bilateral primary,secondary augmentation mammoplasties and mastopexy with augmentation mammoplasties by the author between April 1999 and February 2015.Each breast was taken as a single unit for a total of 5,544 breasts.Results:There were 2,334 patients in primary augmentation mammoplasty,258 in secondary augmentation mammoplasty and 180 in simultaneous mastopexy with augmentation mammoplasty.There were three autoinflation of breasts due to late seromas identified in the series.All patients presented at least six months following augmentation mammoplasty and all had textured implants place in muscle splitting submuscular pocket.There was no late seroma noted in secondary augmentation mammoplasty or simultaneous mastopexy with augmentation mammoplasty.All patients were treated conservatively without a recurrence.Conclusion:Late autoinflation of the breast due to seroma is an uncommon clinical complication and can be treated conservatively in the first instance.

Inferior dermoglandular flap for autologous breast remodeling following explantation of breast implants in ptotic breasts:a case report and literature search

Explantation following aesthetic mammoplasty without implant replacement is quite uncommon and often leaves the patient worse off than prior to mammoplasty.A case is presented here in which patient’s own tissue was used as an inferior dermoglandular flap for autologous breast remodeling.Inferior dermal flap has been described for breast reconstruction and simultaneous augmentation mammoplasty with mastopexy for prosthesis cover in the lower pole of the breast,but its use following explantation without implant replacement has not been described for breast remodeling and volume conservation.

A long term review of augmentation mastopexy in muscle splitting biplane

Aim:Simultaneous or single stage mastopexy with augmentation is challenging,unique and commonly performed by a plastic surgeon.In this procedure pocket for implant placement,marking for envelope reduction and type of implants used can affect the outcome of the procedure.Muscle splitting pocket for mastopexy is a plane described by the author for implant placement with a short term follow up.The use and outcome of the technique is presented with a larger series and a long term follows up to evaluate the efficacy of the procedure.Methods:Retrospective data was collected.Augmentation was performed using muscle splitting technique and periareolar,vertical scar and wise pattern were used for skin reduction and mastopexy.A single surgeon performed all procedures.Results:In total 108 patients mastopexy with augmentation in muscle splitting technique.The mean age of the patient was 32.2 years(range:18-67 years)with an average follow up of 4.5 years(range:3 months to 10 years).All patients had round textured cohesive gel silicone implants with a mean size of 308 cc(range:200-555 cc).Wound infection was seen in 4(3.7%),wound breakdown in 7(6.5%)patients.Drains were used in 25(23.1%).All patients were treated as day cases and revision surgery was performed in 12(11.1%).There was no hematoma,deep venous thrombosis(DVT)or nipple areolar complex in the series.Conclusion:Simultaneous augmentation mastopexy in muscle splitting pocket can be performed with good aesthetic results along with an acceptable revision rate.

Use of the multiplane internal mastopexy for ptosis correction revision-augmentation mammoplasty

Aim:Augmentation mammoplasty is a commonly performed procedure with a high satisfaction rate.Multiplane pocket was described for simultaneous internal mastopexy and augmentation using inframammary crease incision for selected primary and secondary mammoplasties.The use of the technique is presented with a larger experience for correction of ptosis in a patient presenting for revision surgery following subglandular augmentation mammoplasty.Methods:A retrospectively collected data were analyzed using the Excel Spread Sheet.A total of 25 patients had multiplane augmentation with the internal mastopexy following augmentation mammoplasty in subglandular pocket.Data of 25 patients who had their revision surgery in multiplane were analyzed.Results:The group included 25 patients with a mean age of 36.6 years(range:25-54 years)with mean implant duration of 6.4 years(range:1.5-13 years).Twenty-three of the patients were nonsmokers,1 smoker and 1 patient’s smoking status was not mentioned.Eighteen patients presented with grade I capsular contracture,3 patients with grade II contracture and 4 patients had a combination of grade I and II capsular contracture.Pseudoptosis was present in 6,class B ptosis in 6,A/B ptosis in 3,water-down deformity in 5 and rippling in 5 patients.Average preoperative size of implant used initially was 334.4 mL(range:250-340 mL)and the mean implant size selected for revision surgery was 416 mL(range:260-525 mL).Mean follow-up time was 18 months(range:6-48 months).Of 25 patients,21 had a bilateral procedure whereas the technique was used unilaterally in 4 patients for the correction of asymmetry.All patients had a single dose of intravenous antibiotics and followed by an oral course for 5 days,there was no infection noted in the series.In the current series,no patient required revision surgery following the multiplane internal mastopexy.Conclusion:Multiplane internal mastopexy can be useful in selected cases of revisionary augmentation mammoplasty.

An overview of aesthetic surgery of the breast

Aesthetic surgery for the breast is one of the common procedure performed by an aesthetic plastic surgeon today.The surgery is frequently performed for aesthetic as well reconstructive reasons.Breast itself is a uniquely important part of the female body and as such embodies in itself anatomical,physiological and aesthetic role.A proportionately developed breast is an important feminine feature,a sign for fertility and sexuality.It is not surprising that breasts are extremely important for women’s self-confidence especially when their role in society has expanded immensely.