Breast Augmentation Research Articles

Contralateral Autologous Augmentation in DIEP Flap Reconstruction: Employing Computed Tomography Angiography and Volumetric Analysis for Preoperative Planning.

Autologous reconstruction accounts for approximately 20% of all breast reconstruction procedures. In cases of unilateral reconstruction, contralateral breast augmentation using autologous tissue can be performed to improve symmetry, and it is a viable option for patients interested in having more volume relative to their current size without the use of implants. Computed tomography scans have been used for preoperative planning in autologous reconstruction to evaluate available perforators. In this article, the authors report their experience using computed tomography angiography for preoperative volumetric assessment for autologous contralateral breast augmentation in the setting of unilateral autologous breast reconstruction. Twelve patients underwent autologous augmentation during the study period. The average reconstruction flap weight was 561.2 ± 253.6 g, and the average augmentation flap weight was 218.0 ± 133.7 g. No patients experienced flap loss. The authors demonstrate that the predicted volumes for the augmented and reconstructed breasts were comparable to the actual respective flap volumes. In addition, postoperative patient-reported outcome measures demonstrated high levels of satisfaction across multiple BREAST-Q subscales. This study demonstrates the utility of using computed tomography angiography to estimate reconstructive volumes to help preoperative planning and achieve predictable postoperative breast volumes. It also supports that contralateral autologous augmentation is a good option for patients who would like to avoid implants and are interested in a small to moderate increase in size. Therapeutic, IV.

Silicone Leakage From Breast Implants and its Association With Capsular Contracture in 657 Patients.

Capsular contracture is a common complication following breast reconstruction and augmentation, but there is limited evidence for the association between silicone leaking from the implant and capsular contracture. To determine the association between silicone leaking into the surrounding fibrous capsule and the risk of capsular contracture. This multicenter cross-sectional study included patients undergoing revisional surgery for any indication following breast reconstruction or augmentation with silicone implants. Silicone in the fibrous capsule was quantified using histopathological analysis, and capsular contracture was diagnosed using the Baker classification. Multivariable logistic regression was used to assess the association between the amount of silicone leakage and the predicted risk of capsular contracture. The association was tested in a sensitivity analysis excluding potential confounders and misclassifications. Among 657 included patients (1147 breasts), 272 patients (346 breasts) had either unilateral or bilateral capsular contracture. Capsular contracture was significantly associated with the amount of silicone in the fibrous capsule (p<.001), independent from the time of implantation (p<.001). The risk of capsular contracture increased rapidly by 12% (95%CI 5.0-18), going from 0.00 mL (0-32nd percentile) to 0.26 mL (60th percentile) of silicone in the fibrous capsule. The association was confirmed in the sensitivity analysis of 421 patients (654 breasts) with intact implants. Even small amounts of silicone leakage are associated with a significantly increased risk of capsular contracture. This highlights the importance of using breast implants with low silicone leakage rates such as highly cohesive implants to prevent capsular contracture.

Explantation Mastopexy Using Long Superior Dermoglandular Flap: A Retrospective Analysis of our Technique.

The 2021 ISAPS global survey shows a 49.6% rise in demand for breast implant explantation from 2017. The current challenge is to formulate a standardized technique of mastopexy after explantation, which counters the volume deficit and skin redundancy post removal of implant, giving aesthetically pleasing breast. In this paper, we describe the technique of explantation mastopexy based on superiorly based infra-areolar dermoglandular flap and retrospectively analyse the data for past 3 years. After Institutional review approval, a retrospective analysis of data extracted for breast explantation and mastopexy using the author's technique was done from 1st June 2021 to 31st August 2023. The surgery was performed by the principal author in a single centre. A post-operative Breast-Q questionnaire after 2 weeks for outcome analysis was sent through email. A total of 150 patients were operated during study time period with mean age of 47.85 ± 9.71years. The reasons for explantation included patient no longer feeling the need for breast implant (66%), breast implant-associated illness (27.33%), implant rupture (4.66%) and capsular contracture (2%). Explanation surgery was seen after mean duration of 14.70 ± 5.68 years after breast augmentation. The post-operative outcome was uneventful for 141 cases (94%). On analysis of questionnaire, 67.8 was mean score for satisfaction with breasts and 56.4 for satisfaction with outcome of surgery for the 100 responses received. The surgical technique here uses a superiorly based infra-areolar dermoglandular flap which uses own inferior breast tissue to provide upper and medial pole fullness by tacking to pectoral fascia providing a sturdy anchor. The use of inferior breast tissue to augment the central mound shifts up the inframammary crease. The study also objectively evaluates outcome using Breast-Q questionnaire analysis but lacks comparison with other techniques. Superiorly based infra-areolar dermoglandular flap with folding and tacking to pectoral fascia is a safe technique to manage post breast implant explantation volume deflation. 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 .

Analysis of the Volume of the Liposuction-Derived Adipose Tissue in Clinical Application.

The strategy of adipose component transplantation has been proposed and widely used in both reconstructive and aesthetic surgery. However, there is no uniform standard for the preparation of component fat, and the volume calculation of liposuction and injection in clinical applications is mostly based on experience. This study aims to analyze the volume of component fat obtained during clinical series. Patients undergoing abdominal or thigh liposuction and autologous component fat grafting from September 2020 to October 2024 were included. The high-density fat was harvested from the inferior one-third layer of the standard Coleman fat. The SVF-gel was obtained by mechanical emulsification and centrifugation of the oil layer and upper two-third layer of adipose tissue. Correlation analysis was conducted between the volume of SVF-gel and patient characteristics. Sixty-five with an average age of 33.9 years were included. For breast augmentation, the volume of prepared high-density fat and SVF-gel were 331.7±70.8 and 60.3±13.1mL, with the proportion of SVF in fat aspirated amounting to 6.4%±1.9%. For the treatment of temporal depression, the volume of prepared high-density fat and SVF-gel were 48.3±27.3 and 14.5±8.6mL, respectively, with the proportion of SVF in fat aspirated amounting to 10.3%±2.0%. There was a significant difference between the proportion of SVF-gel in low-density fat and aspirated fat obtained from the abdomen and thigh. There is a significant negative correlation between the obtained SVF-gel proportion with BMI and the amount of fat aspirated. For the preparation of a large amount of SVF-gel, especially for individuals with high levels of BMI, the total volume of fat aspirated would be much higher. Level IV.

Subcutaneous Lower Pole Release as Double Bubble Prevention in Constricted Base Breasts: The "Plus One" Augmentation Technique.

Breasts with a broad base, constricted inframammary fold (IMF) and a short distance between the nipple and the IMF are predisposed to form a double bubble (DB) deformity. Most publications have focused on the correction of a DB rather than on its prevention and thorough analysis of the IMF. Introduction of a third dissection plane in breast augmentation for preventing or correcting DB deformities. This study is a retrospective analysis conducted by a single surgeon, involving 46 patients with a well-defined constricted IMF who underwent breast augmentation with the 'Plus One' technique between 2019 and 2021. Women who required mastopexy were excluded. All procedures were analyzed for lower pole curvature using visual and graphical photographic analysis. The lower pole breast contour was plotted as a graph for better comparison of outcomes. Breast-Q surveys were conducted before and 3 months after surgery. Follow-ups were done at 2 weeks, 6 months, and 12 months after surgery. The curve of the postoperative lower pole was convex in 96% of the cases. In 4%, the curve tends to straighten out in the lower pole. In one case, the curve became concave at one point indicating a DB deformity, making a DB complication rate of 2%. The mean preoperative satisfaction score was 43±2, and the postoperative satisfaction score was 94±3 on the BREAST-Q scale. The "plus one" method showed stable and satisfying results and is easily reproducible with a low complication rate. This can also be used as either a prophylactic or corrective measure.

Concentration of Povidone-Iodine Pocket Irrigation in Implant-Based BreastSurgery: A Scoping Review.

In implant-based breast surgery, microbial contamination of implant surfaces predisposes complications such as overt periprosthetic infection and has been linked to capsular contracture (CC). Anti-microbial practices, including povidone-iodine (PVP-I) breast pocket irrigation, are routinely employed to minimise these risks. No standardised protocol for using this antiseptic exists, particularly concerning the ideal concentration. This review investigates how PVP-I concentration affects outcomes in these procedures while highlighting research gaps. Using PRISMA-ScR guidelines, a systematic search was conducted across MEDLINE, Embase, Scopus, and PubMed databases from their inception to June 2024. Studies were screened using pre-determined criteria for inclusion. The methodological quality of relevant studies was assessed using the MINORS tool. Data regarding basic characteristics, PVP-I irrigation implementation, and outcomes (primarily periprosthetic infection and CC) were extracted for analysis. Nine articles, primarily observational studies, and retrospective analyses were included. These mainly focused on breast augmentation with a few including reconstruction. There was considerable heterogeneity in surgical techniques, and reported PVP-I concentrations ranged from 4 to 20%. This was further confounded by frequent mixing of irrigation solution with antibiotics. Although infection and CC rates were frequently reported, most studies did not specify outcome data for patients receiving PVP-I irrigation. While PVP-I irrigation is extensively used in implant surgeries, the current evidence base is insufficient to determine the optimal concentration and application techniques. This review underscores the need for further detailed research to establish evidence-based guidelines for PVP-I use, aiming to improve patient care and surgical outcomes in breast surgery. 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 .

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

Abstract Background 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, implant distortion. Objectives The aim of this meta-analysis was to investigate how implant and surgical characteristics affect rates of capsular contracture after breast augmentation. Methods A systematic review and meta-analysis were performed in PubMed MEDLINE, EMBASE (OvidSP), and Cochrane Library. Comparison groups included smooth versus textured implants; subpectoral versus prepectoral implant placement; saline versus silicone implants. Odds ratios (OR) were calculated for capsular contracture for each of these groups. Results Twenty-four studies met the inclusion criteria. Smooth implants were associated with significantly higher capsular contracture rates compared to textured implants [OR = 2.80 (95% confidence interval [CI]: 1.92, 4.08)]. Subpectoral implant placement demonstrated significantly reduced capsular contracture rates compared to 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)]. Conclusions 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 to 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.

Presentation and Management of Silicone Lymphadenopathy: A Single Institutional Retrospective Cohort Study.

Silicone Lymphadenopathy (SL) is a complication of breast implants that involves migration of silicone to nearby soft tissue/lymph nodes. Data on its clinical features and management is scarce. We aimed to identify the clinical presentation and management of SL. A single-institution retrospective cohort study was conducted from our institutional imaging system where search terms "Silicone lymphadenopathy", "silicone adenitis" and "silicone adenopathy" were used to identify patients with SL (January 2016-September 2023). Patient demographics, clinical features, imaging findings, pathological investigation, and treatment were obtained from the medical records. Of 52 patients with SL, breast augmentation accounted for 90.4% of the implant placements. All patients had silicone implants placed at some time. A significant portion of patients (69.3%) were asymptomatic, while 7.7% had non-tender lymphadenopathy, 19.2% experienced painful lymphadenopathy, and 1.9% presented with mixed symptoms. Implant rupture was observed in 88.7% of cases; 13.0% intracapsular, 26.1% extracapsular, 15.2% both, and unknown in 45.7%. Axillary nodes were the most commonly involved (86.5%), and ultrasonography was most commonly used to detect SL (80.7%). Biopsy was performed in 17.3% of cases, confirming benign pathology in all cases. No patients required surgical excision of lymph nodes for management of SL. Most patients with SL are asymptomatic and are managed with observation. Biopsy and surgical intervention should be reserved for those patients with abnormal imaging or persistent symptoms. Evaluation of lymphadenopathy is essential to exclude malignancy in patients with a history of breast cancer. 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 .

The Influence of Artificial Breast Volume Induction on Postural Stability, Postural Orientation, and Neuromuscular Control in Healthy Women: A Cross-Sectional Study

(1) Background: The percentage of breast augmentations has increased in recent years alongside the frequency of implant removals. Musculoskeletal and postural disorders are often overlooked during this removal process. Research indicates that excess anterior load from breast implants can disrupt postural control and potentially lead to short- or long-term musculoskeletal dysfunction. This study aims to evaluate the immediate changes in postural control after artificial breast augmentation in healthy female volunteers. (2) Methods: Spinal angles, the center of pressure (CoP), and electromyographic activity of the spinal muscles were recorded in the static position and during the functional reach test (FRT) without and with implants of different volumes (220 mL, 315 mL, and 365 mL). Subjective perceptions of effort, comfort, weight, and performance in the FRT were also assessed. (3) Results: Statistical differences were significant in the scapular elevator during the one-minute standing position (lower activation with the 220 mL implant compared to the control and 315 mL) and in the trapezius muscles during the FRT (lower activation in the upper trapezius in the 315 mL vs. control in the reach phase and 220 mL vs. control in the return phase and higher activation in the lower trapezius in the 315 and 365 mL vs. control in the reach phase). Additionally, significant differences were identified in the performance of the FRT and the associated subjective perceptions. (4) Conclusions: Breast implants with sizes of 220, 315, and 365 mL can alter scapular neuromuscular control, but these differences do not seem substantial enough to result in negative biomechanical effects in the short-term analysis.

Application of Ultrasound Radiomics in Differentiating Benign from Malignant Breast Nodules in Women with Post-Silicone Breast Augmentation.

To evaluate the diagnostic value of ultrasound radiomics in distinguishing between benign and malignant breast nodules in women who have undergone silicone breast augmentation. A retrospective study was conducted of 99 breast nodules detected by ultrasound in 93 women who had undergone silicone breast augmentation. The ultrasound data were collected between 1 January 2006 and 1 September 2023. The nodules were allocated into a training set (n = 69) and a validation set (n = 30). Regions of interest (ROIs) were manually delineated using 3D Slicer software, and radiomic features were extracted and selected using Python programming. Eight machine learning algorithms were applied to build predictive models, and their performance was assessed using sensitivity, specificity, area under the ROC curve (AUC), accuracy, Brier score, and log loss. Model performance was further evaluated using ROC curves and calibration curves, while clinical utility was assessed via decision curve analysis (DCA). The random forest model exhibited superior performance in differentiating benign from malignant nodules in the validation set, achieving sensitivity of 0.765, specificity of 0.838, and an AUC of 0.787 (95% CI: 0.561-0.960). The model's accuracy, Brier score, and log loss were 0.796, 0.197, and 0.599, respectively. DCA suggested potential clinical utility of the model. Ultrasound radiomics demonstrates promising diagnostic accuracy in differentiating benign from malignant breast nodules in women with silicone breast prostheses. This approach has the potential to serve as an additional diagnostic tool for patients following silicone breast augmentation.

A Threshold Technique Study to Understand Patient Preference for Smooth Versus Textured Breast Implants.

Breast implant surfaces are categorized as smooth or textured. Compared with smooth implants, textured surface implants have a higher risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) but may have a lower risk of capsular contracture (CC). This study aimed to quantify whether survey respondents would be willing to accept a higher risk of BIA-ALCL in exchange for the potential reported benefits of textured breast implants. We fielded a threshold technique survey to 405 respondents from 4 cohorts: (1) patients with breast cancer who were considering but did not receive reconstruction with implants, (2) patients with breast cancer who had received reconstruction with implants, (3) persons considering breast augmentation with implants, and (4) patients who had received breast augmentation with implants. The average maximum increase in the risk of BIA-ALCL that the survey respondents were willing to accept in exchange for textured implants-with both a teardrop-shaped option and a 10% reduction in the risk of CC-were as follows: 0.83% for patients who were considering breast reconstruction, 0.61% for patients who had received breast reconstruction, 0.85% for persons considering breast augmentation, and 0.60% for patients who had received breast augmentation. We found respondents generally were willing to accept the higher risk of BIA-ALCL associated with textured implants to gain the potential benefit of reduced risk of CC and the option of the teardrop-shaped implant. Patient perspectives and preferences are integral, and continued assessment of patient perspectives can help inform regulatory and care paradigms.

Atypical Origin of Lateral Pectoral Nerve: A Case Report

In the present case, two Lateral Pectoral Nerves (LPN) were in the right axilla. The upper branch, superior LPN arose from the proximal part of the axilla deep to the clavicle from the anterior division of the upper trunk. This branch descends medially and enters the deep surface of the pectoralis major muscle. A larger LPN is seen originating from the distal part of the right lateral root of the median nerve at the lower part of the axilla, medial to the third part of the right axillary artery. This inferior LPN is 2 cm long, descends medially, and joins with the Medial Pectoral Nerve (MPN) forming ansa pectoralis. The branches from the ansa pierce the pectoralis minor muscle and enter the pectoralis major muscle. It supplies both the pectoral muscles. LPN fibers passing from the Lateral Cord (LC) through the lateral root of median have not been reported yet. The LPN is the main nerve of pectoralis major muscle. A thorough understanding of Pectoral Nerve (PN) anatomy is a must for surgeons practicing mastectomies, breast augmentation surgery, axillary dissection, harvesting pectoralis major muscle island flap, and dealing with trauma and fracture of the shoulder.

PRS Journal Club: Breast Augmentation Plane Selection, Bleeding in Rhinoplasty, and Medical Spa Practitioner Trends.

PRS Journal Club: Breast Augmentation Plane Selection, Bleeding in Rhinoplasty, and Medical Spa Practitioner Trends.

TYPES OF POSTOPERATIVE AESTHETIC COMPLICATIONS AFTER BREAST ENDOPROSTHETICS (review of the leading researches)

Background. The digital indicators of the International Society of Aesthetic Plastic Surgery for 2018, 2021 and 2022 indicate a trend of steady increase in demand for breast endoprosthetics (augmentation mammoplasty) with various implants, in particular, in 2022 there was an increase in the number of transactions by 29% compared to 2021. However, in addition to the increase in demand for breast augmentation, there is also an increase in the number of postoperative aesthetic complications worldwide, in particular, specific to these interventions, malposition of implants in the long-term postoperative period. Aim: to review the leading researches on the types of postoperative aesthetic complications after breast endoprosthetics. Material and methods. The review of the leading researches was based on the identification of scientific publications devoted to the study of the specifics and features of surgical intervention in the cosmetic procedure of breast augmentation in the free search engine for biomedical research PubMed (from the US National Library of Medicine and the US National Institutes of Health), as well as in the open access search engine Google Scholar. As a result of the analytical search, the formed array of selected publications became the basis for a professional review of sources to determine the causes of postoperative specific aesthetic complications after breast endoprosthetics. Results. The review describes the pathogenesis of the main postoperative aesthetic complications that can develop after breast augmentation and presents the views of medical scientists on improving the breast augmentation procedure and preventing further complications. Conclusion. The effect of implants on the surrounding tissues, including muscles, has not been sufficiently studied. Prevention of malposition during breast arthroplasty with modern microtextured and smooth implants of the latest generation has not been sufficiently developed. Traditionally, the literature focuses on preventive measures to create an adequate implant pocket volume, prevent fluid accumulation around the prosthesis and biofilm formation. Therefore, breast endoprosthetics (augmentation mammoplasty) requires further improvements to prevent the possible occurrence and further development of any complications after surgical interventions during cosmetic procedures.

Chest Feminization and Masculinization Surgery: Part Two of the Plastic Surgeon's Perspective of Gender-Affirming Surgery.

Transgender individuals commonly feel significant distress and discomfort, termed gender dysphoria, as a result of the discrepancy between their gender assigned at birth and their gender identity. A major source of gender dysphoria stems from distinct anatomical differences between the male and female chest. Gender-affirming mastectomy of transmasculine patients and breast augmentation for chest feminization of transfeminine patients, also referred to as top surgery, are often the first surgical interventions and most commonly pursued physical modifications for the treatment of gender dysphoria among this patient population. Surgical modification of the chest improves psychological functioning, relieves distress from gender dysphoria symptoms, and has low rates of postoperative regret. This article aims to explicate the various top surgery options available to clinicians to aid their transgender patients' goal of achieving an outward appearance more closely aligning with their gender identity.

Transcriptome of capsular contracture around breast implants mimics allograft rejection: a matched case-control study.

Capsular contracture is a frequent and severe complication following breast implant surgery. Although several theories on the pathophysiology exist, the exact molecular mechanisms remain unclear. This study aimed to identify the specific genes, signaling pathways, and immune cells associated with capsular contracture. Breast implant capsule biopsies were collected from women undergoing implant replacement after breast augmentation. Patients with capsular contracture (Baker III/IV) and healthy controls (Baker I) were included in equal numbers and matched based on implant brand, surface, plane, and rupture status. Whole transcriptome RNA-sequencing was used for gene expression profiling. We analyzed biopsies from 51 breasts of 50 women, revealing 1,500 differentially expressed genes based on capsular contracture status. Our findings revealed that capsular contracture signaling pathways mimic allograft rejection with activation of both the innate immune system (e.g., IL1A/B, CXCl9, TREML4, CR1) and the adaptive immune system (e.g., CD80 and IFN-γ). Capsular contracture was associated with increased expression of macrophages, CD4+ T cells, B cells, and plasma cells with upregulation of several immunoglobulin genes (e.g., IGHD/IGHE). Moreover, several fibrosis-related genes were significantly upregulated (e.g., MMP1, MMP1, MMP12) and downregulated (TIMP4) in breasts with capsular contracture. The results indicate that B cells play a more crucial role in the development of capsular contracture than previously assumed. The disease mechanism resembles allograft rejection, indicating that capsular contracture is a form of immunological rejection of the breast implant. This study identified key genes associated with capsular contracture, suggesting new drug candidates e.g., MMP1 inhibitors to improve breast implant surgery outcomes. Synergizing research on allograft rejection and capsular contracture could also lead to new treatment strategies.

The Dark Side of 3D Simulation in Breast Augmentation: How to Use Its Advantages and Avoid Its Drawbacks.

The Dark Side of 3D Simulation in Breast Augmentation: How to Use Its Advantages and Avoid Its Drawbacks.

Surgical Trauma Comparison of Inframammary Fold versus Endoscopic Transaxillary Approaches in Breast Augmentation: A 7-Year Cohort Study.

This retrospective cohort study aimed to assess differences in surgical trauma between the inframammary fold approach and endoscopic transaxillary approach in breast augmentation surgery. One hundred and ninety-four patients who underwent breast augmentation using either an inframammary fold or endoscopic transaxillary approach were enrolled. All procedures were primary and bilateral cases. Patients' demographics and indicators, such as operation duration, postoperative volume of drainage, drainage duration, length of hospital stay, and postoperative pain scores, were observed and analyzed. One hundred and five patients underwent inframammary fold incisions, while the remaining 89 received transaxillary incisions. The operation duration was significantly shorter in the inframammary fold group than in the transaxillary group, while the VAS scores were significantly lower (p < 0.001). Similarly, differences in the age and fertility status between the two groups were statistically significant (p < 0.05). However, no statistically significant differences were noted in the scores of the remaining indicators (p < 0.05). This research demonstrated that while patients in the endoscopic transaxillary group were typically younger, which is commonly hypothesized to result in superior results, the inframammary fold approach may offer a surgical option with reduced trauma and pain and concomitantly greater convenience and efficiency, yielding high satisfaction levels among Chinese women. 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.

Capsular Contracture After Breast Augmentation: Our Approach to Prevent Reoccurrence with Combined Total Capsulectomy and Implantation of Motiva Ergonomix® Implants.

Breast augmentation is the second most common aesthetic surgery worldwide. Capsular contracture, a prevalent complication which affects up to 30% of patients post-surgery, often leads to further necessary surgeries. This study investigates the effectiveness of total capsulectomy combined with Motiva Ergonomix® implant replacement in resolving capsular contracture and minimizing recurrence rates. We conducted a retrospective study of 1067 patients and enrolled 51 women with capsular contracture post-breast augmentation. Patients were treated between 2014 and 2023 in a single center by three surgeons. Capsular contracture severity was graded using Baker's classification. Surgical interventions included total capsulectomy and implant replacement, using various incision techniques and changes in implant anatomical planes. Patients were followed up for a minimum of 12 months to a maximum of 9 years. A total of 51 patients with grade III or IV capsular contracture underwent revisional surgery, involving the implantation of 102 Motiva Ergonomix® prostheses; 77 explanted implants resulted intact, 15 exhibited silicone bleeding, and 10 showed ruptured. Capsular contracture recurrence was observed in only 1.96% of cases during the follow-up period. The combination of total capsulectomy and implantation of Motiva Ergonomix® implants significantly reduces the recurrence rate of capsular contracture. Despite the study's limitations, including its single-center design and a small sample size, our results suggest that this approach is a viable and effective solution to manage this common complication in breast augmentation patients. Further multicentric studies are recommended to validate these results. 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 https://www.springer.com/00266 .

The Influencing Factors of Breast Morphological Changes After Dual-Plane Augmentation with Smooth Round Implans: A Correlational Study.

Breast morphology is the primary objective indicator for evaluating the outcome of augmentation surgery. Studies have indicated that breast morphology undergoes certain changes during the early postoperative period, which may result in a discrepancy between postoperative outcomes and preoperative design. This study utilized three-dimensional scanning technology and statistical methods to analyze the influencing factors of breast morphology changes, aiming to provide reference for implant selection and preoperative surgical planning. The study included patients who underwent endoscopic-assisted transaxillary dual-plane augmentation from July 2020 to June 2022. Anthropometry and three-dimensional scanning were performed on the enrolled patients, and the change values of postoperative breast morphological parameters were calculated. Spearman rank correlation tests were performed to assess the correlation between these changes and implant parameters as well as anthropometric measurements. Factors with high correlation were selected, and multivariate linear regression analysis was conducted. A total of 30 patients (60 breasts) were enrolled. The average downward displacement of the inframammary fold was 0.4 ± 0.3 cm, and the average outward displacement of the medial breast border was 0.2 ± 0.1 cm, both highly positively correlated with implant volume. The length of nipple-medial breast border increased by 0.5 ± 0.3 cm, highly positively correlated with the stretchability of the medial pole. The length of the nipple-to-inframammary fold increased by 0.6 ± 0.3 cm, highly positively correlated with implant volume and stretchability of the lower pole. Nipple displacement was 0.3 ± 0.2 cm outward, highly positively correlated with the stretchability of the medial pole. Nipple elevation was 0.2 ± 0.2 cm, highly positively correlated with implant volume and stretchability of the lower pole. Breast projection decreased by 0.4 ± 0.2 cm, highly positively correlated with preoperative breast projection. The average reduction in breast volume was 25.6 ± 15.7 cc, with the reduction value highly positively correlated with preoperative breast volume. After smooth round implant augmentation mammoplasty, the breasts experienced slight downward and outward displacement, with the main influencing factor being the implant volume. Nipple displacement outward and upward, as well as lateral displacement, was primarily influenced by the stretchability of the medial pole. Upward displacement was mainly influenced by implant volume and the stretchability of the lower pole. The increase in length of the nipple-to-inframammary fold skin was most significantly influenced by implant volume and the stretchability of the lower pole. Breast convexity and volume gradually decreased, with preoperative breast size having the most significant impact on these changes. 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 .