Patients Seeking Breast Augmentation Research Articles

Transumbilical Silicone Breast Augmentation: A 13-Year Experience and 5-Year Analysis.

Transumbilical breast augmentation (TUBA) with saline implants has been considered a safe and efficient technique for decades. However, because silicone implants are more popular than saline ones, TUBA with saline implants is not widely performed. In 2014, we published a report on transumbilical breast augmentation using silicone cohesive gel implants. As we have performed transumbilical silicone breast augmentation (TUSBA) for 13 years with slight modifications, this study aimed to describe this novel technique and present accompanying patient outcomes over 5 years. We enrolled patients desiring breast augmentation at a single center. The preoperative design was initially determined with the patients in standing positions before they underwent surgery under general anesthesia in a supine position. Between January 2018 and December 2022, 69 women and one man underwent TUSBA at a single center. All patients underwent cohesive gel silicone implantation in the subpectoral pocket. The implant size varied from 225 to 300mL (average 272mL) because two patients underwent surgery with implants of different sizes due to breast asymmetry. All patients were satisfied with the surgery outcome except one who was dissatisfied because of abdominal bulging. TUSBA offers advantages such as minimal scarring and unrestricted arm movement; thus, it can be an alternative option for patients seeking breast augmentation. 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 .

Internal Mastopexy: A Novel Method of Filling the Upper Poles During Dual-Plane Breast Augmentation Trough Periareolar Incision.

Breast ptosis is a deformity commonly found in patients seeking breast augmentation. Current mastopexy techniques rely on incisions on the breast to correct ptosis; nonetheless, they leave extensive scars. Having to opt for a visibly scarred breast over a ptotic breast can be a difficult choice. We sought an innovative internal suture mastopexy for hypomastia of mild breast ptosis. A procedure that left a tiny scar on the nipple-areolar complex was introduced. This method was safe and efficient when combining mastopexy with augmentation. Overall, 53 patients underwent this operation in the Plastic and Cosmetic Department of Guangdong Second Provincial General Hospital from January 1, 2013, to June 30, 2017, with a mean follow-up of 38 ± 16 months. The pre-operation and post-operation SN-N lines (the distance from the sternal notch to the nipple) were 21.8 ± 1.2 cm and 20.7 ± 1.0 cm, respectively; the difference was statistically significant (P<0.05). The patients and surgeon expressed satisfaction with the procedure. Based on the results of the present study, which included more than 50 patients, we believe that internal suture mastopexy can be used as an effective alternative hypomastia in patients with mild breast ptosis. IV 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. .

Augmentation Mastopexy with Surgical Excision of the Lower Pole to Avoid Waterfall Deformity: A Surgical Technique and Nipple Areolar Complex Case Series.

Purpose of this article is to demonstrate a way of avoiding the waterfall deformity in augmentation mastopexy patients. We will show a case series of results and explain how this technique gives satisfying aesthetic results for patients seeking breast augmentation who also require mastopexy. We will show how addressing the breast parenchyma on the lower pole via direct excision can give reliable results and avoids the waterfall deformity. The surgical technique used by the senior author combines the principles of breast augmentation, mastopexy, and breast reduction. We apply these principles during the initial single operation. Our goal is to achieve the best anatomical results for the patient. We describe 1538 consecutive patients whom underwent single-stage breast augmentation with mastopexy. All implants were submuscular with 12% being saline and 88% were silicone implants. Vertical mastopexies were performed in 8% and wise pattern incisions were used in 92%. There were no life-threatening complications such as deep vein thrombosis, pulmonary embolism, and so on. Tissue-related complications included wound infection (1%) and hematomas (1%). Implant-related complications included malposition or implant displacement 9% and capsular contracture 1%. Aesthetic complications included dystopia of NAC (4%) and volume asymmetries (10%). Revision surgery was tissue related (2%), implant related (3%), and aesthetic related (10%). There were no cases of waterfall deformity seen in the cohort. In conclusion, we believe that the technique detailed here is easy to do, uses principles already known of breast augmentation and reduction and gives consistent results with low reoperation rates.

New Guidance for Gynecologists Counseling Adolescents on Breast and Labial Surgeries

The American College of Obstetricians and Gynecologists has published guidance for clinicians counseling adolescent patients seeking breast augmentation or reduction surgeries or labiaplasties. The group recommends the following:

Evaluation of wait times for patients seeking cosmetic and reconstructive breast surgery.

Patients seeking cosmetic or reconstructive procedures in plastic surgery typically face significant wait times for consultations. Little attention has been given to potential disparities in wait times between elective cosmetic and reconstructive procedures. In this initial pilot study, we audited a broad sample of plastic surgery offices within a single state for wait times in initial consultations for both breast reconstruction and breast augmentation. A sample of board-certified plastic surgeons was audited from the American Society of Plastic Surgeons (ASPS) Web site that listed both cosmetic and reconstructive breast surgery. Scripted patient telephone calls were made to 67 plastic surgery clinics within a single state on May 2012. Two calls separated by 7 days were made to each office by the same actor seeking an initial appointment for either breast reconstruction or breast augmentation. Wait times were calculated from the date of the call until the date of appointment offered. There were 72 paired calls completed on 36 plastic surgery clinics. Significant disparities in appointment wait times existed between elective cosmetic versus reconstructive procedures (P = 0.02). Mean wait times for breast reconstruction consultation (26.1 days) were significantly longer than mean consultation wait times for breast augmentation (20.9 days). Interestingly, 17.9% of offices contacted no longer perform certain procedures currently advertised on the ASPS Web site. Disparities exist in access to care between patients seeking elective breast augmentation and reconstruction after mastectomy. Patients seeking breast augmentation have more rapid access to plastic surgeons. This study did not evaluate possible explanations for the observed differences. Potential causes may include physician preference and compensation benefits for cosmetic procedures.

Fat Grafting and Breast Reconstruction with Implant

In postmastectomy radiated patients, autologous tissue reconstruction is preferred over implant reconstruction, because the latter is associated with a higher rate of postoperative complications. Autologous tissue reconstruction, however, is not always feasible and is sometimes refused by the patient. A challenge also arises in breast-conserving surgery patients seeking breast augmentation with an implant. In this article, the authors present a further reconstructive option for irradiated breast cancer patients consisting of fat grafting followed by implant placement. The authors retrospectively reviewed 16 cases of irradiated breasts treated with fat grafting and subsequent alloplastic reconstruction/breast augmentation. The evaluation methods were clinical and photography-based assessments. The BREAST-Q was used to quantify patient satisfaction. Sixteen patients, with a pretreatment Late Effects on Normal Tissues-Subjective, Objective, Management, Analytic (LENT-SOMA) score of 1 or 2, underwent two to three fat grafts to achieve a LENT-SOMA score of 0. The placement of the breast implant had been performed in a separate stage at least 3 months after the last grafting session. The average follow-up was 15 months. Reconstructive outcomes were graded from excellent to good in 93.7 percent of patients. Patient satisfaction was marked as high to very high. There were no short-term complications. A Baker grade 1 capsule contracture was found in all patients. The authors' experience shows that breast fat grafting followed by implant placement may represent a feasible reconstructive option in highly selected patients with irradiated breasts. Fat grafting seems to reduce radiation-induced complications in implants. Larger studies with a longer follow-up are needed. Therapeutic, V.

Increase of Visible Veins After Breast Augmentation

A retrospective study was undertaken to determine the pre- and postoperative presence of visible veins in the skin across the breast of patients seeking breast augmentation, and the impact of this phenomenon on patient satisfaction. From a series of 97 consecutive patients who underwent cosmetic breast augmentation surgery, 78 patients were available with sufficient 3-view pre- and postoperative (first available moment within 3-26 weeks postoperatively) photographic material available for analysis. A venous prominence scale was developed to grade the extent and amount of venous visibility in the skin across the breast and to compare the preoperative situation with the postoperative outcome. Additional information on patient's characteristics and self-reported opinions related to pre- and postaugmentation body images were obtained using a structured self-administered questionnaire. Preoperatively, minimal visibility of veins in the skin across the breast (grade 1) was already present in more than half (59%) of the patients seeking breast augmentation. After augmentation, there was an increase in visible (prominent) veins in almost all (96.2%) patients, generally by 1 or 2 grades, according to our venous prominence scale. Questionnaire analysis revealed that few patients are aware of this phenomenon, and even fewer patients dislike it. Many patients seeking breast augmentation already have minimal visibility of veins in the skin across the breast that increases in almost all patients after augmentation. It was quite striking that only few patients seemed to be aware of this phenomenon, and even fewer patients seemed to dislike it.

Psychological Considerations in Cosmetic Breast Augmentation

Within the past decade, the popularity of cosmetic breast augmentation has surged and, with it, the interest in the psychological aspects of the procedure. Investigations of women who seek cosmetic breast augmentation have examined both their psychosocial characteristics and their motivations for surgery. Dissatisfaction both with body image and with breast size and/or shape are thought to be primary motivators for surgery. It is common for women seeking cosmetic breast augmentation to have some body image dissatisfaction. However, a considerable minority may suffer from excessive dissatisfaction consistent with the psychiatric diagnosis of body dysmorphic disorder, which is believed to contraindicate cosmetic surgery. Following breast augmentation, most women report satisfaction with the aesthetic result and improvements in body image. The impact of the procedure on other areas of functioning, such as self-esteem and quality of life, is less clear. These positive outcomes have been tempered by recent epidemiological studies that have identified a relationship between cosmetic breast implants and suicide. This article reviews this literature and provides recommendations to plastic surgical nurses regarding the psychological assessment and management of patients seeking breast augmentation.

MOC-PS(SM) CME Article: Breast Augmentation

After studying this article, the participant should be able to: 1. Evaluate patients seeking breast augmentation using key variables to assist in selection from the choices for incision, implant type and size, and plane of dissection. 2. Minimize the need for revisionary surgery to factors beyond the surgeon's control. The purpose of this article is to provide guidelines for Maintenance of Certification continuing medical education using the breast augmentation module. It may be used as an aid in the extraction of data for 10 consecutive cases of breast augmentation and, in this regard, provides a template to facilitate the collection of pertinent information. Interspersed with the Maintenance of Certification-oriented format is continuing medical education information regarding the current state of practice concerning the multiple variables in the specific procedure of breast augmentation.

Breast Augmentation Today: Saline versus Silicone—-What Are the Facts?

Controversy breeds excitement, and the epic saga of breast prosthesis in the United States has been no exception. In 1992, U.S. plastic surgeons began what can be considered an experiment. With new U.S. Food and Drug Administration restrictions, saline breast implants became the only option available to patients seeking breast augmentation surgery. This restriction spanned the course of almost 15 years. Initially, when we treated patients desiring breast augmentation, we were hopeful that one day silicone implants would be available again to provide our patients with a variety of options and choices. In 2006, the experiment ended as the Food and Drug Administration approved silicone implants for general clinical use in breast augmentation. A vociferous buzz surrounding silicone implants ensued, resulting in new interest and questions from our patients. With the promise of “new cohesive gels” and better durability, the floodgate was opened, and many of us have again embraced the use of silicone gel implants for breast augmentation. A recent survey conducted by the American Society of Plastic Surgeons revealed that the majority of responding members felt that many primary augmentation patients would return to exchange their saline implants for silicone implants.1 Further, members anticipated that more than 60 percent of future primary augmentation candidates would request silicone implants.1 Underneath all of this enthusiasm, have we found ourselves “back to the future”? If it were not for the health concern controversies surrounding silicone implants, which have been largely unsubstantiated in the scientific literature, it is conceivable that saline implants would never have been thoroughly investigated in the United States. The controversies led to multicenter trials and Food and Drug Administration endorsement of the safety of saline implants.2 With the reintroduction of silicone implants, comparisons between silicone and saline are inevitable. Although there is an abundant amount of general data concerning silicone implants, the relative brevity of follow-up for the current silicone implants approved recently by the Food and Drug Administration makes the analysis between saline and silicone implants unbalanced. We are now told about the “new generation” of silicone gel implants, but long-term data are not yet available. Although the current data are alluring, we must remember a straightforward fact: the data from the latest generation of silicone implants are approximately 3 to 4 years old. As physician and scientists, we know that long-term, verified, scientific knowledge is needed on potential changes in the contracture and rupture rates of these implants. One advantage of the moratorium on silicone implants was the long-term collection of data on saline implants. This data collection period spanned more than 15 years in the United States, and the information gathered substantiated that saline implants are safe and effective in our patients. Despite the uncertainty of outcomes with silicone implants, a plethora of data exists. What are the data and what should we discuss with our patients in consultation? The data we currently have are less than clear. With regard to rupture rates, studies have shown an 8to 13-year average for silicone implants; corporate data also cite a 0.5 to 3 percent 3to 4-year rupture rate.3–6 In their 2006 study, Heden et al.5 found that the rupture rate was 8 percent for silicone implants; this was contrasted with a rupture rate of 4.3 percent for saline implants,7 which increased with variance in time (Table 1). At 10 years, third-generation silicone gel implants are projected to maintain integrity at a rate of 83 percent to 85 percent; this estimate,

Psychological Considerations in Cosmetic Breast Augmentation

Within the past decade, the popularity of cosmetic breast augmentation has surged and, with it, the interest in the psychological aspects of the procedure. Investigations of women who seek cosmetic breast augmentation have examined both their psychosocial characteristics and their motivations for surgery. Dissatisfaction both with body image and with breast size and/or shape are thought to be primary motivators for surgery. It is common for women seeking cosmetic breast augmentation to have some body image dissatisfaction. However, a considerable minority may suffer from excessive dissatisfaction consistent with the psychiatric diagnosis of body dysmorphic disorder, which is believed to contraindicate cosmetic surgery. Following breast augmentation, most women report satisfaction with the aesthetic result and improvements in body image. The impact of the procedure on other areas of functioning, such as self-esteem and quality of life, is less clear. These positive outcomes have been tempered by recent epidemiological studies that have identified a relationship between cosmetic breast implants and suicide. This article reviews this literature and provides recommendations to plastic surgical nurses regarding the psychological assessment and management of patients seeking breast augmentation.

Differences in breast shape preferences between plastic surgeons and patients seeking breast augmentation.

There has been little discussion in the published literature regarding breast shape preferences. This study was conducted to ascertain previously undocumented differences in breast shape preferences between plastic surgeons and patients seeking breast augmentation, with respect to upper-pole contour. Sixty-six respondents, grouped into three cohort categories (plastic surgeons, breast augmentation patients, and lay people), were asked to evaluate a series of 12 nonptotic breast profiles representing a range of upper-pole contours. Five profiles exhibited convex upper-pole contours, five exhibited concave contours, and two exhibited upper poles with flat slopes. A five-point Likert-type scale was used to rate attractiveness, naturalness, how close the shape was to each respondent's personal ideal, and how close the shape was to what the respondent believed was our society's ideal. Statistical comparisons were made among the three cohorts. The plastic surgeon cohort (n = 11) rated concave upper-pole contours significantly higher than did the patient cohort (n = 13) for attractiveness, naturalness, and personal ideal (p < 0.01). For convex contours, the plastic surgeon cohort gave significantly lower scores than did the patient cohort (p < 0.01). The lay category (n = 42) demonstrated preferences intermediate between those of the other groups. There are no known studies in the literature documenting the breast shape preferences of plastic surgeons and their patients. This study suggests that plastic surgeons and patients seeking breast augmentation may have drastically different images in mind regarding what constitutes an attractive, natural, and ideal breast shape. These findings have potential implications for patient treatment and satisfaction.

Differences in Breast Shape Preferences between Plastic Surgeons and Patients Seeking Breast Augmentation; Henry C. Hsia, M.D., and J. Grant Thomson, M.D.

Differences in Breast Shape Preferences between Plastic Surgeons and Patients Seeking Breast Augmentation; Henry C. Hsia, M.D., and J. Grant Thomson, M.D.

Prefilled Saline Breast Implants Offer Significant Advantages

Thomas M. Biggs, MD, Houston, TX , is a board-certified plastic surgeon and an ASAPS member. Approximately 20 months ago, I started using prefilled saline breast implants as an alternative to conventional saline implants, which are filled at the time of surgery. I was interested in evaluating devices made by Poly Implants Prosthesis Corporation (Miami, FL) to see whether a prefilled saline breast implant offered a better result to patients seeking breast augmentation or reconstruction. The shell material is manufactured by a unique platinum-catalyst process that yields a thin yet durable device. …