Breast Augmentation Procedures Research Articles

Current Advances in Artificial Intelligence in the Field of Aesthetic Surgery and Breast Augmentation: Short Review

Study design: This review is structured as a systematic analysis of the literature to evaluate the impacts of artificial intelligence (AI) on the field of plastic surgery, with a focus on breast augmentation and aesthetic surgical procedures. Key areas of exploration include advancements in machine-learning techniques relevant to plastic surgery, the integration of AI into preoperative planning processes, and the historical evolution of AI in aesthetic surgery. The review also systematically assesses current AI tools specifically developed for breast augmentation, such as 3D imaging and predictive analytics, to understand their efficacy and role in clinical practice. Objective: This article explores the current state and future prospects of AI in plastic surgery, with a focus on breast augmentation and aesthetic procedures. Emphasis is placed on the benefits, challenges, and the imperative for collaborative efforts in the integration of AI technologies. Methods: Advancements in machine-learning algorithms and AI technologies are examined for their potential in automating the assessment and enhancement of surgical skills. The role of AI in facilitating objective evaluations in aesthetic surgery is discussed, addressing challenges such as the lack of standardized training datasets and integration issues. The importance of mitigating potential biases introduced by AI to ensure objectivity in patient assessments is highlighted. Results: The article discusses the historical evolution of AI, from Alan Turing’s conceptualization to contemporary applications in aesthetic surgery. Artificial intelligence’s ability to analyze vast patient datasets is explored, showcasing its potential for offering personalized treatment recommendations and improving accuracy over time. Specific AI tools for breast augmentation, including Canfield Mirror, QuantifiCare LifeViz Infinity Pro, Crisalix, BreastGAN, Arbrea Breast Software (ABS), and Deep Surface AI, are examined in detail, emphasizing their advantages and drawbacks. Conclusions: Evaluation of clinical photography techniques, relying on specific hardware, is presented, with consideration given to the potential of AI-based illumination systems to enhance consistency in preoperative images. The review concludes by envisioning the transformative future of AI in aesthetic surgery, considering its untapped potential in diagnostic imaging, personalized treatment plans, and enhanced surgical precision through integration with virtual and augmented reality. Despite challenges, the promises of AI in personalized treatments, precise patient care, and improved surgical assistance suggest a transformative future for plastic surgery, contingent on addressing current concerns. Collaborative efforts are deemed essential for the successful implementation of AI technologies in the field.

Testing Mechanical Properties of Silicone Gel-Filled Breast Implants and Their Degradation.

Breast augmentation procedures using silicone implants have become increasingly popular over the past six decades. This article addresses the concerns of patients regarding implant strength by providing clinicians with valuable information in addition to video and pictorial evidence to share, fostering reassurance. The article focuses on the structural integrity and stability of breast implants, which play a critical role in their long-term performance and patient satisfaction. Specifically, it examines the industry standards outlined by the International Organization for Standardization (ISO), with a particular emphasis on ISO14607-2018, which encompasses a range of mechanical and physio-mechanical tests, including the assessment of silicone gel-fill firmness, evaluation of shell integrity, and examination of the impact of environmental conditions on implant performance. Breast implants are not static devices and are subject to aging and fatigue-based degradation. This emphasizes the need for ongoing monitoring and evaluation to ensure the long-term safety and satisfaction of patients. By providing a comprehensive examination of breast implant structure and industry standards, this article equips clinicians with the necessary knowledge to address patient concerns and foster confidence in the safety and longevity of breast augmentation procedures using silicone implants.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 .

Long-Term Satisfaction with Breast Augmentation and Augmentation Mastopexy in the Latin American Population.

The primary objective of this study was to determine the long-term satisfaction levels of women who have undergone breast augmentation and augmentation mastopexy procedures, while identifying the factors influencing patient satisfaction. A self-reported retrospective case study design was used to collect data from women with breast implants. The study employed a survey that included demographic information, preoperative diagnosis, implant details, and patient-reported outcomes measured using the Breast-Q Instrument, which evaluates satisfaction with breasts, self-esteem, sexual well-being, and physical symptoms. Statistical analyses were conducted to identify correlations and differences in outcomes between the different variables. The survey was completed by 1022 women from 19 countries, with Chile, Mexico, and Colombia being the most represented. Augmentation was performed on 72.2% of the patients, while 27.7% underwent augmentation mastopexy. Patient satisfaction with breast size and shape varied significantly between the two procedures, with patients undergoing augmentation mastopexy showing less satisfaction. In addition, patients who were unaware of their implant shape or placement reported lower satisfaction scores. The study also found that patient satisfaction decreased over time in the augmentation mastopexy cases and that patients with high body mass index had lower satisfaction. Augmentation mastopexy in patients with breast ptosis yields lower satisfaction than augmentation alone. Dissatisfaction escalates with overweight/obesity (BMI), post-surgery time, and misinformation. Implant pocket (pre-vs. subpectoral), shape (round vs. anatomical), and size did not impact satisfaction. 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 .

Subfascial Mini Muscle-Release Dual Plane Technique: A Modified Procedure for Breast Augmentation.

Each breast augmentation technique has advantages and indications, and the quest for the perfect implant pocket plane is ongoing. An ideal dual plane should meet three requirements: adequate implant coverage, optimal control of breast shape, and maximal muscle preservation. This paper reports a modified procedure for breast augmentation named subfascial mini muscle-release dual plane technique. From an inframammary or periareolar approach, the implant pocket is dissected in a subfascial plane up to the pectoralis major. The muscle is split 3 cm above the lateral margin and then pocket dissection proceeds in the submuscular plane. A small portion of the costal origin is divided inferomedially creating a dual plane. A total of 178 patients with hypoplasia or breast atrophy were included, among whom 34 had breast ptosis and 20 had tubular breast deformity. The median follow-up period was 20 months. With an average implant volume of 268.8 ml and a smooth implant type of 85.4%, there was 1 case of hematoma, 2 cases of wound healing issues, 2 cases of rippling sign, 2 cases of grade III/IV capsular contracture, 5 cases of implant malposition and 12 cases of mild muscle contraction-associated deformity. Revision surgeries were performed on 2 patients. The subfascial mini muscle-release dual plane technique is an easy method for breast augmentation and is especially indicated for ptotic breasts and tubular breast deformities. This technique combines the advantages of traditional dual plane and muscle-splitting techniques, yielding a satisfactory aesthetic outcome.

Updated trends of breast implant surgeries: An Israeli analysis

Breast augmentation remains one of the most prevalent procedures in plastic surgery. While most patients experience high satisfaction with the outcomes, a subset may encounter various complications or dissatisfaction with achieved results necessitating subsequent surgical intervention including implant removal or exchange. We collected information from three pivotal private medical centers in Israel where a considerable number of breast surgeries are performed. We examined the number of breast augmentations, implant exchange and implant removal surgeries with or without breast lift that were performed on a biannual basis for each center for the period 2018-2022. Trends in surgery types were analyzed and compared to registries in other countries. Between the years 2018 and 2022, 20,075 surgeries were done in three main private medical centers in Israel. Data show a gradual increase in implant removal surgeries from 2018 (n=80, 2.9%) to 2019 (n=269, 9.9%), followed by a significant increase in 2020 (n=1436, 27.3%), and a gradual decline between 2021 (n=1019, 22.8%) and 2022 (n=916, 18.5%). The overall number of breast implant insertion procedures (breast augmentation procedures and exchange procedures) was 2659 in 2018 (97%), 2424 in 2019 (90.0%), 3816 in 2020 (72.6%), 3437 in 2021 (77.1%), and 4019 in 2022 (81.4%). We present updated trends in breast implant surgeries in Israel. 2020 was a key year in which the rate of explantations was the highest, and the percentage rate of implantations was the lowest and a year in which the trend changed. These patterns partly align with trends seen in other countries worldwide.

Transcriptomic and machine learning analyses identify hub genes of metabolism and host immune response that are associated with the progression of breast capsular contracture

Capsular contracture is a prevalent and severe complication that affects the postoperative outcomes of patients who receive silicone breast implants. At present, prosthesis replacement is the major treatment for capsular contracture after both breast augmentation procedures and breast reconstruction following breast cancer surgery. However, the mechanism(s) underlying breast capsular contracture remains unclear. This study aimed to identify the biological features of breast capsular contracture and reveal the potential underlying mechanism using RNA sequencing. Sample tissues from 12 female patients (15 breast capsules) were divided into low capsular contracture (LCC) and high capsular contracture (HCC) groups based on the Baker grades. Subsequently, 41 lipid metabolism-related genes were identified through enrichment analysis, and three of these genes were identified as candidate genes by SVM-RFE and LASSO algorithms. We then compared the proportions of the 22 types of immune cells between the LCC and HCC groups using a CIBERSORT analysis and explored the correlation between the candidate hub features and immune cells. Notably, PRKAR2B was positively correlated with the differentially clustered immune cells, which were M1 macrophages and follicular helper T cells (area under the ROC = 0.786). In addition, the expression of PRKAR2B at the mRNA or protein level was lower in the HCC group than in the LCC group. Potential molecular mechanisms were identified based on the expression levels in the high and low PRKAR2B groups. Our findings indicate that PRKAR2B is a novel diagnostic biomarker for breast capsular contracture and might also influence the grade and progression of capsular contracture.

Infective Costochondritis after Augmentation Mammoplasty: A Rare Case Report and Review of the Literature.

Silicone breast implant insertion is a commonly performed surgical procedure for breast augmentation or reconstruction. Among various postoperative complications, infection is one of the main causes of patient readmission and may ultimately require explantation. We report a case of infective costochondritis after augmentation mammoplasty, which has rarely been reported and is therefore difficult to diagnose. A 36-year-old female visited the clinic for persistent redness, pain, and purulent discharge around the left anteromedial chest, even after breast implant explantation. Magnetic resonance imaging showed abscess formation encircling the left fourth rib and intracartilaginous and bone marrow signal alteration at the left body of the sternum and left fourth rib. En bloc resection of partial rib and adjacent sternum were done and biopsy results confirmed infective costochondritis. Ten months postoperatively, the patient underwent chest wall reconstruction with an artificial bone graft and acellular dermal matrix. As shown in this case, early and aggressive surgical debridement of the infected costal cartilage and sternum should be performed for infective costochondritis. Furthermore, delayed chest wall reconstruction could significantly contribute to the quality of life.

Efficacy of Acellular Dermal Matrix Type in Treatment of Capsular Contracture in Breast Augmentation: A Systematic Review and Meta-Analysis.

Capsular contracture is a known complication of breast augmentation and is among the top reasons for revision breast augmentation procedures. The use of acellular dermal matrices (ADM) has been shown to reduce the rate of capsular contracture in breast reconstruction and augmentation theorizing that it acts as a protective barrier between the implant capsule and inflammatory process responsible for capsular contracture. The role of ADM in treatment of capsular contracture has been investigated in numerous studies, using a variety of ADM. The aim of this study was to perform a systematic review of existing literature on the use of ADM for treatment of capsular contracture in aesthetic breast augmentation patients to investigate differences in efficacy between ADM types. PubMed, Embase, and CINAHL databases were systematically reviewed for articles pertaining to capsular contracture, acellular dermal matrices, and breast augmentation. Number of patients, type of ADM, Baker grade, follow-up time, complication rate, and capsular contracture rate were recorded from identified articles. Data was pooled from studies to calculate a capsular contracture rate for each ADM type with Chi-squared test performed for analysis. Identified studies with a comparative group were included in meta-analysis utilizing risk ratio (RR) to assess efficacy of ADM. Nine articles using ADM for treatment of capsular contracture in breast augmentation met criteria for inclusion with a total of 481 breasts. Strattice (Lifecell Corporation, Branchburg, NJ) was the most commonly used ADM (n=391), followed by AlloDerm (n=57; Lifecell Corporation). There was a statistically significant difference in efficacy of ADM among the studied ADM types (p < 0.001). AlloDerm, FlexHD (MTF Biologics, Edison, NJ), and DermaMatrix have the lowest capsular contracture rates (0%). NeoForm (Mentor Corporation, Irving, TX) and SurgiMend (Integra LifeSciences, Princeton, NJ) have the highest capsular contracture rates (each 25%, but with n=4 and n=8, respectively). Strattice has a capsular contracture rate of 1.53% in the pooled data, and meta-analysis showed that Strattice reduces the risk of capsular contracture (RR 0.14 [95% CI 0.06, 0.31]) compared to conventional treatment. Acellular dermal matrices appear to be effective at treating capsular contracture after breast augmentation while maintaining a low complication rate. Overall capsular contracture rates are low with the use of ADM. There is a statistically significant difference in efficacy among ADM type. Meta-analysis shows that Strattice is effective at reducing the risk of capsular contracture in breast augmentation patients compared to conventional treatment. Future research, especially in the form of randomized-controlled trials, is needed to further investigate the efficacy of various ADM in the treatment of capsular contracture.

The Optimal Layer for Breast Augmentation in an Autologous Fat Grafting Murine Model.

Fat grafting is an effective procedure for breast augmentation, but the variations in this technique result in unpredictable fat retention. Therefore, animal models are needed to simulate the operation and the optimal layer for fat retention. An autologous fat grafting murine model for breast augmentation was built to detect a new layer for fat grafting in the chest. The left side of the female rat inguinal fat flap was harvested, dissected into small pieces, and autotransplanted into 3 different layers of the breast. Retention rate and hematoxylin and eosin (H&E) staining were measured at 1, 4, 8 12, and 16 weeks. Immunofluorescence staining was utilized to detect adipocytes and endothelial cells, and immunohistochemistry was conducted to evaluate the expression of integrins β1 and α6. The volume of fat grafts slightly grew in the intramuscular and submuscular layers at Week 4. Retention rates in the subcutaneous layer and submuscular layer were significantly higher than the intramuscular layer at Week 16. H&E staining showed that oil cysts existed in the subcutaneous layer throughout the 16 weeks. At the terminal time point, well-vascularized mature adipose structures were observed in intramuscular and submuscular layers, with smaller adipocytes in intramuscular layers. Immunohistochemistry analysis showed that integrin β1 was identically expressed in every adipocyte in all the layers, whereas integrin α6 selectively expressed in bigger adipocytes in the intramuscular layer. The expression intensities of integrin β1 and α6 were significantly higher in the intramuscular layer than in the subcutaneous and submuscular layers. The angiogenic and moderate mechanical environment makes the submuscular layer the optimal layer for fat retention.

Perioperative Management of Estrogen Therapy As It Relates to Venous Thromboembolism in Aesthetic Surgery Patients

Abstract Goals/Purpose Perioperative management of estradiol therapy varies considerably among plastic surgeons performing aesthetic surgeries. This study aimed to review available literature regarding perioperative management of estradiol therapy in aesthetic surgery patients, and the risk it poses for developing VTE in the perioperative period. Methods/Technique A literature search was performed using online databases to identify studies evaluating VTE in aesthetic surgery patients taking oral contraceptives (OCPs) or hormone replacement therapy (HRT), and transgender patients on feminizing hormone therapy undergoing non-flap feminization surgery (facial feminization and breast augmentation procedures). Reported outcomes were extracted from these studies and summarized. Results/Complications A systematic review of the literature yielded 225 studies. Five of these studies met inclusion criteria. One study that was excluded, referenced an article that met inclusion criteria, which was ultimately included in our review for a total of six studies, representing 3,635 patients. Conclusion Data regarding perioperative management of estrogen therapy is limited in the literature, and standardized guidelines for aesthetic surgery patients have not been elucidated. This has led to inconsistencies in how estrogen is managed for elective, cosmetic procedures. Further research is needed to determine standardized practice guidelines. In the meantime, case-by-case evaluation of surgical appropriateness should continue. Surgeons should also consider risk-mitigating strategies, such as a focus on patient education, more intentional patient questioning regarding estrogen-containing product use, a preoperative coagulability workup for patients with a personal or family history indicative of possible coagulopathy, and specialty-wide efforts to create an aesthetics database and evidence-based guidelines.

Factors impacting informed consent in cosmetic breast augmentation

BackgroundFor women who undergo cosmetic breast augmentation, their post-operative risk assessment may not match their pre-operative understanding of the involved risks and likelihood of revision surgeries. This may be due to the potential issues surrounding whether patients are being fully informed about all possible risks and related financial implications during the consent phases of patient/doctor consultation. MethodsTo explore comprehension, risk preference, and perceptions of breast augmentation procedure, we conducted a recorded online experiment with 178 women (18–40 years) who received varying amounts of risk-related information from two experienced breast surgeons in a hypothetical first consultation scenario. ResultsWe find patient's age, self-rated health, income, education level, and openness to experience to be significant factors impacting initial breast augmentation risk preferences (before receiving any risk information). Further, more emotionally stable patients perceived greater breast augmentation risks, were less likely to recommend breast augmentation, and were more likely to acknowledge the likelihood for future revision surgery. After providing women with risk-related information we find increases in risk assessment in all treatment conditions, and that increased amounts of risk information do decrease women's willingness to recommend breast augmentation. But that increased risk information does not appear to increase women's assessment of the likelihood of future revision surgery. Finally, we find some participant individual differences (such as education level, having children, conscientiousness and emotional stability) appear to impact risk assessment post receiving risk information. ConclusionContinuous improvement of the informed consent consultation process is vital to optimising patient outcomes efficiently and cost-effectively. Greater acknowledgement and emphasis on disclosure of related risks and financial burden when complications arise is also important. As such, future behavioural research is warranted into the factors impacting women's understanding both prior to and across the BA informed consent process.

Pectoral Nerve Blocks for Breast Augmentation Surgery: Comment.

I read the recently published article on pectoral nerve blocks (PECS) for breast augmentation procedures with immense interest.1 I greatly appreciate the authors for analyzing the efficacy of PECS blocks on breast augmentation procedures and congratulate them for publishing this wonderful study on this topic that has only a few studies in the literature. I wish to present my reflections on it.Aarab et al.1 mentioned that theirs is the first study to provide PECS blocks after general anesthesia but before surgery, thereby facilitating sensory block during surgery itself. However, to my knowledge, there are few more studies that have provided PECS blocks before the commencement of surgical procedure (breast augmentation). For instance, in a recently published study by Schuitemaker et al.,2 surgery of the first breast (right-side) was started 20 min after the completion of PECS block plus serratus plane block. In another recently published study also,3 the PECS I block was advocated before surgery. Indeed, Desroches et al.3 performed the PECS I block before the induction of general anesthesia itself. In addition, they found that PECS I block is not superior to sham block for providing postoperative pain relief when the patients were made their own control too for one side versus the other side.3 In contrast to these studies, a study released in December 2020 by Ciftci et al.4 compared the preoperative versus postoperative administration of PECS I block in breast augmentation and concluded that preoperative PECS I was superior to postoperative PECS I and the control group. Furthermore, PECS blocks were performed either preoperatively or intraoperatively (after induction of general anesthesia but before surgery) in many studies according to a meta-analysis by Hussain et al.5 involving various breast cancer procedures.Aarab et al.1 used the phrase “combined PECS I and PECS II blocks,” which is incorrect because PECS II block includes both PECS I (a pectoral component; i.e., injection between pectoralis major and minor) and an additional component (subpectoral component; i.e., injection between pectoralis minor and serratus anterior).Last but not least, the references are misquoted in a few places in the article. In the Introduction, while referring to the meta-analysis by Hussain et al.5 that concluded PECS blocks were not inferior to paravertebral blocks, Aarab et al.1 quoted references 17 to 20. However, these references do not match that sentence. Similarly, in the Discussion, while referring to Hussain et al.5 again, Aarab et al.1 mistakenly cited the quote as coming from reference 18 instead of from reference 16. In addition, in the Results, reference 31 was quoted for French law regarding exclusion criteria. However, it should have been reference 33.Support was provided solely from institutional and/or departmental sources.The author declares no competing interests.

Six-Year Evaluation of Motiva Round and Ergonomix SmoothSilk Surface Silicone Breast Implants: A Two-Center, Two-Surgeon Outcome Analysis of 1053 Primary and Secondary Breast Augmentations and Augmentation Mastopexy.

The emerging concerns around breast implant-associated anaplastic large cell lymphoma and other chronic inflammatory-related conditions have instigated a wider use of smooth devices. The authors aimed to present 6-year data following the introduction of Motiva implants (Establishment Labs Holdings Inc.; Alajuela, Costa Rica) into their previously texture-dominated practice. Additionally, the authors aimed to provide technical recommendations on how to efficiently incorporate these devices into surgical practice and minimize the learning curve. Data of 1053 primary and secondary breast augmentations conducted between April 2015 and December 2020 in 2 centers (Victoriakliniken in Sweden and the European Institute of Plastic Surgery in Cyprus) were retrospectively evaluated to obtain data on chosen implant characteristics and complications that led to reoperation, prior to and following modifications to surgical practice in 2018. The data from 6 consecutive years demonstrate a low device-related complication rate with Motiva implants. In 2018, following adaptions in surgical practice, the complication rate significantly declined. Motiva implants demonstrate a low complication rate and safety profile for women undergoing primary and secondary breast augmentation procedures. However, to reap the benefits of the antifibrotic profile, technical adaptions and optimal patient planning based on the patient and device characteristics are instrumental. Employing the key principles laid out in this study provides a means for delivering both clinically safe options to patients with aesthetically pleasing long-term results.

The modified inframammary fold suture method and its clinical significance in primary augmentation mammoplasty.

The inframammary approach is one of the most commonly used incisions in breast augmentation. There are many suture methods for inframammary incisions; however, no one method has proven optimal. We modified the traditional three-layer suture method according to the inframammary fold (IMF) cadaver dissection results. This study aims to investigate whether using a modified suture method can improve postoperative outcomes. Cadaver dissections were performed in order to clarify the anatomy of the IMF. From June 2013 to December 2017, a retrospective study of primary breast augmentation patients subjected to the inframammary approach was conducted. Patients were divided into two cohorts: the traditional suture method and the modified suture method. The patient's demographics, specifics of breast augmentation procedures, complications, and scar assessment were analyzed. Univariate and multivariable analyses were used to determine differences between the two cohorts. One hundred eighty-four patients were included: 75 patients were subjected to the traditional suture method, and 109 patients were subjected to the modified suture method. Wound-related adverse events (p=0.026) and IMF-indented scarring (p=0.014) were significantly different between the two groups. Multivariable analysis showed that the suture method was the most influential factor related to IMF-indented scarring (OR=16.9), followed by BMI (OR=2.9). We defined a new suture method for the inframammary incision in primary breast augmentation. This modified suture method reduces the occurrence of wound-related adverse events and IMF-indented scarring.

Breast augmentation under local anesthesia with intercostal blocks and light sedation

Introduction This study of breast augmentations performed under local anesthesia with intercostal blocks and light sedation describes the outcomes and evaluates benefits and complications. Method From December 2005 until August 2019, 335 women consecutively underwent bilateral breast augmentation procedures. The anesthetic protocol consisted of an initial intravenous bolus of 1 mg midazolam and 0.25 mg alfentanil preoperatively. In 2017, this was changed to 2–4 mg midazolam intramuscularly, 1 mg midazolam intravenously, and 2.5 µg sufentanil intravenously. Intercostal blocks were injected at the midaxillary line into the intercostal spaces two to seven. The operating field was infiltrated with tumescent local anesthesia. Retrospective data extraction from patients’ medical charts was done, registering demographics, dosage of anesthesia, surgical characteristics, complications, and reoperation rates. Results Two hundred and eighty-one women underwent primary augmentation and 54 had implant replacement. The most common complications included suboptimal cosmetic results, asymmetry, and healing-related problems. The overall rate of reoperation was 16.1% within an average follow-up period of 2 years, ranging from 0 to 12.5 years. The majority of the reoperations were due to cosmetic reasons. The change in anesthetic regime was associated with a significantly (p < 0.0001) decreased need for supplementary medication with no increased risk of complications. Conclusion Breast augmentations in local anesthesia with intercostal blocks and light sedation can be performed safely and can serve as an alternative to procedures in general anesthesia.

Breast augmentation using autologous fat grating optimised by negative pressure wound therapy

Introduction: The majority of breast augmentation procedures utilise breast implants to achieve enhancement to shape and volume. However, breast augmentation using autologous fat grafting is gaining popularity. The technique permits volume and shape enhancement whilst avoiding the associated complications of breast implants. However, it can be limited by the degree of achievable volume enhancement, the need for multiple fat transfer procedures and the unpredictable nature of grafted fat take.

Bilateral periareolar hyperpigmentation after augmentation mammoplasty: a case report and literature review

Complications arising from breast augmentation procedures are broadly categorized as either surgery-related or prosthesis-related. Many reports have described complications associated with breast augmentation. However, to date, periareolar post-inflammatory hyperpigmentation (PIH) after breast augmentation has not been reported. Herein, we report a case of PIH after augmentation mammoplasty using a silicone implant through the periareolar approach. A 35-year-old woman, who underwent bilateral breast augmentation using a periareolar approach, presented with bilateral periareolar tissue changes, with dark brown, irregular macules appearing 6 weeks postoperatively. Based on clinical symptoms and histological examination, the lesion was diagnosed as PIH. Topical hydroquinone and retinoic acid were applied for 8 weeks after the pigmentation appeared. After 6 months of observation, the pigmentation faded. To summarize, we report a case of pigmentation around the bilateral nipples after periareolar breast augmentation along with a literature review.

OPTIMAL ANALGESIA FOR BREAST SURGERY ENHANCED RECOVERY IN DAY SURGERY.

Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts. This included breast augmentation, breast augmentation and lifting operations, in a ratio of 2 to 1.According to statistics from the American Association of Plastic Surgeons (ASPS), in 2020 breast augmentation with implants was ranked fifth of all cosmetic surgeries performedand the second largest body surgery immediately after liposuction, with 193,073 procedures done. In addition to these procedures, breast augmentation (87,051) and breast reduction (33,574) procedures were also popular. Due to the increased interestin these procedures and their high daily percentage of operating programs, adequate analgesia and recovery of patients, who undergo these cosmetic breast corrections, areimportant. Today, it is no longer enough for an operation to go well and the patients to have good results. It is also important that the procedure itself, from induction of anesthesia to early and late recovery, allows for a quick return to daily activities and work.

Patient Reported Outcome Measures After Breast Augmentation - Using the BREAST-Q IS.

PurposeCosmetic breast augmentation procedures are commonly performed breast device surgeries. The Australian Breast Device Registry (ABDR) administers a five-question patient reported outcome measure (PROM), the BREAST-Q Implant Surveillance module (BREAST-Q IS), to patients 1, 2 and 5 years after breast device surgery. The measure includes an open-ended question to add any comments. This study aimed to use the responses to this open-ended question to assess participants’ experiences of breast devices 1 and 2 years after breast augmentation. The secondary objective was to identify emerging and important issues relating to breast augmentation and devices.Patients and MethodsThis qualitative descriptive study was conducted using a randomly selected sample of 268 responses to the open-ended question in the BREAST-Q IS, from the ABDR database. These responses were from patients who underwent breast augmentation between 2015 and 2018. Comments were analyzed using conventional content analysis in NVivo 12.ResultsFour major themes were identified: satisfaction following breast augmentation, dissatisfaction following breast augmentation, complications and breast symptoms following breast augmentation and other comments. Two dominant themes were regarding satisfaction (n = 112) with overall surgical outcome, medical team, and post-operative appearance and complications and breast symptoms (n = 177) following breast augmentation. Emerging issues identified were rippling of breast implants and breast implant illness (BII).ConclusionPROMs can be used to understand patients’ perspectives on various aspects of their own surgical experiences. Participants provided responses regarding complications and breast symptoms experienced, and rippling of the breast implants and BII are emerging issues after breast augmentation.

Public Perception of Ideal Breast Shape.

BackgroundIn the past decade, there has been a dramatic increase in trends related to body-shaping procedures. According to the American Society of Plastic Surgeons, nearly 300,000 breast augmentation procedures were conducted in 2019. Learning the ideal shape of a breast and which esthetics lead to public perception of the most attractive breast is beneficial to properly performing these procedures.ObjectivesThe authors aimed to quantify the public’s perception of attraction to breast shape by measuring public opinion for various esthetic elements of breast anatomy and linking this to various demographic factors.MethodsSurvey responses were collected from 1000 users of Amazon Mechanical Turk to collect demographic data and ask users to rank preferences for randomized image panels of breast proportions.Results960 responses were used for analysis. A majority of respondents were male (60%), with a plurality being 25 to 34 years old (49.3%). The most notable preferences between all groups were breast projection proportion and nipple direction, with preferences of 1.0 and frontal nipple direction, respectively. Breast width to shoulder width ratio also had a clear preference among the crowd, with 105% being the preferred percentage, and the 25 to 34 age group having a very strong preference for this.ConclusionsThe authors used a crowdsourcing survey technique with randomized image panels to analyze ideal breast preference using images of various anatomical traits of the female breast. It was concluded that crowdsourcing can be a favorable technique for learning ideal overall preferences for specific anatomy.