Patients Undergoing Augmentation Mammaplasty Research Articles

Perioperative Safety of Combined Augmentation-Mastopexy: An Evaluation of National Database.

The safety of combined augmentation-mastopexy is controversial. This study evaluates a national database to analyze the perioperative safety of combined augmentation-mastopexy to either augmentation or mastopexy alone. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients undergoing augmentation mammaplasty and mastopexy from 2005 to 2018. The patients were divided into the following groups: group I, augmentation; group II, mastopexy; group III, combined augmentation-mastopexy. Baseline characteristics and outcomes were compared. Outcomes were 30-day complications, reoperation, and readmission. We found 5868 (74.2%) augmentation only, 1508 (19.1%) mastopexy only and 534 (6.6%) combined augmentation-mastopexy cases. Mean operative time was highest among the combined group at 129 minutes compared with 127 minutes for mastopexy alone and 66 minutes for augmentation alone (P < 0.01). Rates of any complications and readmission were different among groups (0.8% vs 2.5% vs 1.5% respectively, P < 0.01 and 0.7% vs 1.5% vs 1.5% respectively, P = 0.049), whereas reoperation was not statistically different (1.2% vs 1.4% vs 1.5%, P = 0.75). The incidence of dehiscence (0.6%; P < 0.01) was highest in the combined group. Multivariable logistic regression analysis did not reveal an increased odds of complications, reoperation, or readmission with combined augmentation-mastopexy. An evaluation of the nationwide cohort suggests that combined augmentation-mastopexy is a safe procedure in the perioperative period.

Surgical Timing and the Menstrual Cycle Affect Wound Healing in Young Breast Reduction Patients.

Young female subjects are known to have the highest baseline menstrual hormone levels of any female age group. Studies have found an association between hormone levels and wound healing. This has been researched in the orthopedic, gynecologic, and dermatologic literature, and more recently, in young patients undergoing augmentation mammaplasty. The purpose of this study was to determine whether the timing of surgery relative to the menstrual cycle plays a role in surgical complications following bilateral reduction mammaplasty. All female patients aged 25 years or younger with a documented last menstrual cycle undergoing a bilateral reduction mammaplasty from 2005 to 2013 were reviewed. Surgical timing and postoperative complications relative to the last menstrual cycle were recorded. The preovulatory phase referred to days 1 to 14 after the patient's last menstrual cycle, whereas the postovulatory phase referred to days 15 to 28. Forty-nine patients met inclusion criteria. Undergoing bilateral reduction mammaplasty during the postovulatory phase was associated with development of wound dehiscence and hypertrophic scarring (p < 0.005), which were the most common postoperative complications. Surgery in the preovulatory or postovulatory phase did not affect hematoma, seroma, wound infection, or nipple-areolar complex necrosis rates (p > 0.05). Age, race/ethnicity, body mass index, large resection mass, and medical comorbidities did not affect wound dehiscence or scar hypertrophy rates (p > 0.05). Young patients undergoing bilateral reduction mammaplasty during the postovulatory phase of the menstrual cycle have an increased risk of wound healing issues and poor scarring. This may be attributable to hormonal fluxes occurring during this phase and the already high hormone levels in this population.

Commentary on: Asymmetry of Inframammary Folds in Patients Undergoing Augmentation Mammaplasty.

When patients present with reasonable symmetry in volume, base diameter, and inframammary fold position, breast augmentation can be a predictable, straightforward procedure. Unfortunately, this scenario is not the norm and dealing with preoperative asymmetries in all of these parameters can represent one of the biggest obstacles to providing outstanding results in breast augmentation. It is with this in mind that the findings of this paper prove noteworthy.1 Using computer evaluation software, and admittedly adhering to a strict standard for documenting symmetry, not a single patient in 111 consecutive women was found to be perfectly symmetric. In this patient cohort, differences noted from side to side were found in nipple position, volume, projection, base diameter, and most importantly the position of the inframammary fold. In this study, the right inframammary fold was …

Asymmetry of Inframammary Folds in Patients Undergoing Augmentation Mammaplasty.

Variation in the anatomical position of the inframammary fold (IMF) in women remains poorly studied. The purpose of this study was to evaluate the incidence of asymmetry between IMF locations on the chest wall of women undergoing breast augmentation and to determine breast measurements associated with IMF asymmetry. Three-dimensional imaging analysis of the breasts was performed in 111 women with micromastia, using the Vectra Imaging System(TM). The following measurements were recorded: vertical distance between right and left IMF (inter-fold distance), vertical distance between nipples (inter-nipple distance), and difference between projection of right and left breasts in anterior-posterior direction. Asymmetry between the right and left IMF positions was found in the majority of patients (95.4%), with symmetry only found in 5 patients (4.6%). In the majority of patients (60.3%), the right IMF was located inferior to the left IMF with median inter-fold distance 0.4 cm (range, 0.1, 2.1 cm). In 39 patients (35.1%), the left IMF was located inferior to the right with median inter-fold distance 0.4 cm (range, 0.1, 1.7 cm). There was strong correlation between the degree of asymmetry of IMF and asymmetry of nipple areola complex (NAC) positions (r = 0.687, P < .01). The majority of women with micromastia demonstrate asymmetry of the IMF, which correlates with asymmetry of NAC location. The authors propose a classification system based on most commonly observed IMF locations as types I (right IMF inferior to left), type II (left IMF inferior to right) and type III (both IMF located on the same level). LEVEL OF EVIDENCE 4: Diagnostic.

A Prospective Study on Lipoaugmentation of the Breast

The current standard for breast augmentation involves placement of an implant. As an alternative, surgeons have been exploring breast augmentation with autologous tissue in the form of injectable fat. The authors explore the efficacy and safety of lipoaugmentation of the breast, with specific interest in volume changes, fat retention, overall aesthetic improvement, and patient satisfaction. Direct measurements, 2- and 3-dimensional images, mammograms, and magnetic resonance imaging (MRI) were obtained preoperatively from 10 consecutive patients undergoing augmentation mammaplasty with autologous fat transfer. These measurements were repeated 1 year postoperatively. Postoperative photo imaging was conducted at 3-month intervals for 1 year. Efficacy was evaluated by determining the volume of fat retention 1 year after the procedure with 3-dimensional imaging, standard breast MRI volume measurements, and subjective aesthetic comparisons. The average amount of fat injected was 236 cc (90-324; SD, 69.8) in the right breast and 250 cc (90-300; SD, 65.1) in the left. The mean volume change based on 3-dimensional imaging was 85.1 cc (36% retention) for the right breast and 98.1 cc (39.2% retention) for the left. The mean volume change based on MRI measurements was 30.0 cc (39.8% change) on the right and 29.3 cc (38.1% change) on the left. Blinded observers found substantial improvement in 1 patient (10%), moderate improvement in 5 patients (50%), and minimal to no improvement in 4 (40%). Overall patient satisfaction was high, as measured by the abbreviated BREAST-Q. Radiologic abnormalities and artifacts were common and required additional imaging. Objective breast enlargement in this study was modest but yielded disproportionately high subjective patient satisfaction reports. 2.

A Multi-Institutional Perspective of Complication Rates for Elective Nonreconstructive Breast Surgery: An Analysis of NSQIP Data From 2006 to 2010

As elective nonreconstructive breast surgery increases in popularity, there is greater demand for accurate multi-institutional data on minor and major postoperative complications. The authors utilized a multi-institutional database to compare 30-day morbidities and reoperation rates among the different types of elective nonreconstructive breast surgery. Patients in the National Surgical Quality Improvement Program (NSQIP) participant use file who underwent elective nonreconstructive breast surgery between 2006 and 2010 were identified. Twenty defined morbidities were compared among mastopexy, reduction mammaplasty, and augmentation mammaplasty patients using analysis of variance and χ(2) tests for continuous variables and categorical variables, respectively. Logistic regression modeling was employed to identify preoperative risk factors for complications. Of the 3612 patients identified, 380 underwent mastopexy, 2507 underwent reduction mammaplasty, and 725 underwent augmentation mammaplasty. Complication rates were low in all cohorts, and patients undergoing augmentation mammaplasty had the lowest overall complication rate compared with mastopexy and reduction mammaplasty (1.24%, 2.37%, and 4.47%). Patients undergoing reduction mammaplasty had a modestly elevated incidence of overall morbidity, superficial surgical site infections, and wound disruptions (P < .05). Moreover, 30-day reoperation rates for mastopexy, reduction mammaplasty, and augmentation mammaplasty were low (1.58%, 2.07%, and 0.97%), as were the rates of life-threatening complications (0%, 0.16%, and 0%). One death was observed for all 3612 procedures (0.03%). Elective breast surgery is a safe procedure with an extremely low incidence of life-threatening complications and mortality. Comprehensive data collated from the NSQIP initiative add to the literature, and the findings of this multi-institutional study may help further guide patient education and expectations on potentially deleterious outcomes.

Measurements and analysis of breast morphology changes after breast augmentation by 3D scanning

Objective To evaluate the application of three-dimensional (3D) scanning in the measurements and analyses of breast morphology changes that occur after breast augmentation. Methods Pre- and postoperative breast 3D images were obtained in 18 patients (36 breasts) undergoing augmentation mammaplasty by 3D scanning. All implants were round sillicone and planted under pectoral muscle. Average implant volume was 232.2 mL, and average projection was 3.46 cm. The number of implants in low profile implant group was 12( h ＜ 3.0 cm), and 16 in moderate group ( 3.0 ≤ h ＜ 4.0 cm), 8 in high group ( h ≥ 4.0 cm). The following parameters were measured by Geomagic 10.0: volume, projection, angle and distance of key landmarks, and symmetry degree. Results The increased volume of breast was corresponding with the implant volume (P ＞0.05). Postoperative breast projection was 12.9 %, less than expected projection (preoperative + implant projection). The values in low, moderate, and high profile group were 5.2 %, 15.1%, and 20.2 %,respectively. Conclusion 3D scanning is a quick, convenient, accurate and non-contact method for measurement of breast morphology, and it is promising in breast plastic surgery in the future. Key words: 3D scanning; 3D imaging; Morphometry; Breast augmentation; Breast implant

Correlation Between Scoliosis and Breast Asymmetries in Women Undergoing Augmentation Mammaplasty

Breast asymmetries and scoliosis influence the results of augmentation mammaplasty. Although a variety of methods have been proposed to resolve breast asymmetries, to date, no simple preoperative algorithm has been proposed for predicting the breast volume and decreasing breast asymmetries in the place of subjective or expensive evaluation. The relationship between the scoliosis and breast volume asymmetry was further analyzed statistically in this study. The study enrolled 60 scoliotic patients from 780 patients undergoing augmentation mammaplasty between January 2000 and March 2008. The average follow-up period was 2 years. The inclusion criteria required hypoplastic breasts, a difference in bilateral breast volumes greater than 20 ml, and scoliosis with a Cobb angle greater than 10 degrees . The authors' surgical algorithm demonstrated an anthropomorphic equation for predicting breast volume and selecting the correct implant size. Pearson regression analysis showed that the breast volume asymmetry difference was significantly correlated with the severity of scoliosis (Cobb angle) (correlation coefficient, 0.901). No correlation between the difference in pre- and postoperative nipple and inframammary levels and the severity of scoliosis was noted. Augmentation mammaplasty significantly decreased the breast asymmetry differences (volume and nipple level) (p < 0.001). The average preoperative estimated breast volume was 45.3 ml for the smaller breast and 88.4 ml for the larger breast. This study found that the severity of scoliosis showed significant correlation with the breast volume asymmetry differences. Augmentation mammaplasty for breast asymmetries decreased not only the volume difference but also the difference in nipple levels.

3D Analysis of Breast Augmentation Defines Operative Changes and Their Relationship to Implant Dimensions

Breast augmentation is one of the most common plastic surgery procedures performed in the United States today. Evaluation of postoperative results lacks true objective measurements. The following study reports the application of 3-dimensional (3D) photography to document changes that occur in breast morphology after breast augmentation. Patients undergoing augmentation mammaplasty with a periareolar incision were offered pre- and postoperative 3D photographs. 3D models were constructed and the following parameters were assessed: maximum anterior-posterior projection from the chest wall, angle of breast projection, total breast volume, volumetric tissue distribution in the superior and inferior poles, and surface and vector distance measurements to key landmarks. A completed series of 3D images were obtained from 14 augmentation patients (28 breasts) at an average postoperative day of 143. Saline and silicone implants were used equally (n = 14 for each). Total volume of the breast changed in correlation with the implant size (1.9% difference, P = 0.83). There were no significant changes in the volumetric distribution within the upper and lower poles of the breasts noted between pre- and postoperative scans (P = 0.81). The internal angle of breast projection was found to increase (13.6 degrees, P < 0.01), as did the sternal notch to nipple distance (11 mm, P = 0.018). Anterior-posterior projection significantly increased by 23.3 mm. However, this increase in projection was 20.9% less than expected based on implant dimensions (72.7-58.7 mm, respectively, P < 0.01). This study documents objective changes in breast morphology after augmentation mammaplasty. 3D imaging scans were able to document true changes that occur with breast augmentation including breast volume, the increase in the internal angle of the breast projection, and the sternal notch to nipple distance. 3D photography further highlighted that breast augmentation results in less than expected anterior-posterior projection, possibly due to tissue attenuation occurring anterior to the implant.

Pregabalin Has Opioid-Sparing Effects Following Augmentation Mammaplasty

There has been a recent, growing concern regarding narcotic use in surgical patients. This issue, coupled with an ongoing desire to lessen postoperative discomfort, has prompted the search for alternative analgesic regimens. The purpose of this study was to determine whether the addition of pregabalin, an anticonvulsant indicated for the management of neuropathic pain, to an analgesic regimen reduced narcotic use and reported pain following augmentation mammaplasty. Eighty patients underwent submuscular augmentation mammaplasty with smooth shell saline mammary prostheses in an outpatient surgical facility. The patients were randomized into two groups. Group A (n = 40) used 5-mg hydrocodone tablets as needed to manage postoperative pain. Group B (n = 40) used pregabalin, 75 mg, twice daily in addition to 5-mg hydrocodone tablets as needed for postoperative pain management. Narcotic use was recorded and pain assessed daily using the Rogers Pain Scale from 1 (mild) to 10 (severe). Patients were surveyed for nausea and quality of pain. Group A used 115 +/- 32 mg hydrocodone during the immediate 7 day postoperative period and reported an average pain scale score of 5.3. Likewise, group B used 33 +/- 27 mg hydrocodone as well as the prescribed pregabalin dosage and reported an average pain scale score of 3.4. Patients in group B reported less nausea. These differences were statistically significant (P < .05). Patient age, implant size, and postoperative complications were similar between the two groups. Perioperative pregabalin administration in patients undergoing augmentation mammaplasty reduced postoperative narcotic use by 70%. There was also significantly less reported pain and a 46% reduction in nausea in the pregabalin-treated group. Pregabalin has few side effects, no drug interactions, and should be considered safe in an analgesic regimen.

Anatomic Variation and Asymmetry in Female Anterior Thoracic Contour

This study examines the prevalence of anatomic variation and asymmetry in female thoracic contour and evaluates their effect on breast projection. A consecutive series of 50 female cross-sectional thoracic computed tomography (CT) scans was examined at the level of the fourth rib. Patients with thoracic wall trauma (including surgery) were excluded. Lateral width, anterior-posterior diameter, and 3 internal angles were compared bilaterally and were used to evaluate overall shape and thoracic contour. All patients demonstrated some degree of asymmetry between their right and left sides. A wide range of thoracic shapes was observed. Patients with sloped anterior chest walls have lateral projection of the nipple, while patients with flatter chest walls have anterior projection of the nipple. Evaluating anterior chest wall slope prior to augmentation can help physicians predict postoperative breast projection and thus prepare their patients for the future breast appearance and the potential for contact cleavage.

Celecoxib reduces narcotic use and pain following augmentation mammaplasty

Narcotics have traditionally been used to control pain after augmentation mammaplasty, but they have adverse side effects, including addiction potential, clouded sensorium, nausea, and respiratory depression. Alternative strategies for managing postoperative pain are expensive, cumbersome, and also have their own risks. While long-term use of celecoxib has been associated with an increased risk of serious adverse cardiovascular effects, no problems have been reported with short-term use. The purpose of this study was to determine whether the addition of celecoxib, a selective nonsteroidal anti-inflammatory, to an analgesic regimen reduced narcotic use and pain following augmentation mammaplasty. One hundred patients underwent submuscular augmentation mammaplasty with smooth saline-filled mammary prostheses using an intravenous sedation technique. Group A (N = 50) used hydrocodone to manage postoperative pain. Group B (N = 50) used celecoxib 400 mg 1 to 2 hours before surgery and then daily in addition to hydrocodone postoperatively. Narcotic use, incidence of nausea, and complications were recorded. Pain was assessed daily with a Likert pain scale from 0 (no pain) to 10 (severe pain). Group A used 110 +/- 34 mg hydrocodone during the immediate 7-day postoperative period and reported an average pain scale score of 5.1. Group B, which used celecoxib, used 34 +/- 22 mg hydrocodone during the same period with an average pain scale score of 3.3. These differences were statistically significant (P < .05). Group B experienced 53% less nausea than Group A. There were no significant differences between the groups regarding age, implant size, or complications. Perioperative celecoxib administration in patients undergoing augmentation mammaplasty significantly reduced postoperative narcotic use, pain, and nausea. Its use should facilitate the patient's ability to resume everyday activities following surgery.

Safety, Complications, and Satisfaction of Patients Undergoing Submuscular Breast Augmentation via the Inframammary and Endoscopic Transaxillary Approach

Since its introduction, augmentation mammaplasty has gained widespread popularity, as demonstrated by the fact that an estimated 2 million women in the United States have received implants. During recent decades, several surgical approaches have evolved in terms of implant placement or site of access to the surgical plane. Debate has existed concerning the questionable superiority of a particular technique for achievement of optimal results. Thus, the inframammary approach, an established and widely accepted technique for breast augmentation, and endoscopically assisted transaxillary breast augmentation were retrospectively compared in terms of safety and aesthetic outcome, as measured, respectively, by the rate of postoperative complications and patient satisfaction. This study analyzed 78 patients undergoing augmentation mammaplasty between 1997 and 2004. Only patients seeking primary augmentation mammaplasty solely for aesthetic reasons were included in the study. Previously performed breast surgery and simultaneously conducted ipsilateral mastopexy were among the exclusion criteria. Patient satisfaction was assessed using the client satisfaction questionnaire (CSQ-8) because of its easy applicability. The complication rate was low in both patient subsets, thus confirming the safety of the transaxillary approach, as compared with the more common submammary technique. However, a higher level of satisfaction was detected in the former patient group, indicating a more favorable aesthetic outcome with the transaxillary augmentation mammaplasty. Endoscopically assisted transaxillary augmentation mammaplasty is a safe method with predictable results associated with a high level of patient satisfaction. If applied in the setting of appropriate indications, it is an excellent tool for use with patients who prefer to have an incision at a distant site.

Endoscopic transaxillary submuscular augmentation mammaplasty with textured saline breast implants.

The utility of the endoscope was realized in a retrospective analysis of 92 consecutive patients undergoing augmentation mammaplasty with saline-filled textured implants. The transaxillary submuscular approach was used. All patients received preoperative antibiotics and instillation of methylprednisolone into the saline fill, with inflation to manufacturer-recommended levels. complications included seven implant deflations (3.8%), eight implant malpositions (4.3%), and one capsular contracture (0.6%). Of the eight malpositions, six were corrected using the endoscopic technique without removal of the implant and with early manipulation of the implant within the pocket. We conclude that endoscopic control in augmentation mammaplasty is beneficial in secondary operative procedures and we speculate that the endoscope will lessen the rate of implant malposition observed in this study.

Factors Affecting Mammographic Visualization of the Breast After Augmentation Mammaplasty

To measure the effect of various parameters on mammographic visualization of the breast after augmentation mammaplasty. Preoperative and postoperative mammography was performed in patients undergoing augmentation mammaplasty. The area of breast tissue visualized on each film was measured. Changes in the area visualized were correlated with a variety of different parameters. The Breast Center, Van Nuys, Calif, a free-standing multidisciplinary breast diagnostic and treatment facility. The 68 women (126 breasts) represent a consecutive sample of patients undergoing augmentation mammaplasty for whom preoperative and postoperative mammograms were available. Area visualized was correlated with degree of capsular contracture, implant position, type of mammography, preoperative breast size, implant size, and implant type. The major factor affecting mammography is capsular contracture. Little or no capsular contracture results in a 30% reduction in the area visualized; moderate or severe contracture results in a 50% reduction. Other important factors include implant position (improved visualization with implant beneath pectoral muscle) and type of mammography performed (slightly more tissue seen with displacement technique). Very small preoperative breast size yields increased visualization. Implant size and type have little or no effect. In most women with breast implants, there is a decrease in measurable breast tissue on the postaugmentation mammogram. Capsular contracture and implant position exert a profound effect; type of mammography performed and preoperative breast size are also significant.

Nineteen Yearsʼ Experience with Polyurethane Foam—covered Mammary Prosthesis: A Preliminary Report

Long-term reviews of patients undergoing augmentation mammaplasty seem to be rare. Recently, a long-term study of patients who had undergone augmentation with polyurethane foam-covered prostheses was undertaken. However, at the time that study was published, the longest follow-up was just over 4 years. We have been using the polyurethane-coated prosthesis almost exclusively for nearly 20 years. The procedure is performed by one surgeon using a consistent technique, and all implantations were retroglandular. In reviewing this series, a follow-up rate of nearly 60% was achieved in patients augmented for periods of 1 to 19 years. The length of this study, together with a high follow-up compliance rate, makes this an unusual contribution to the literature on augmentation mammaplasty.

Costal Cartilage Sculpturing as an Adjunct to Augmentation Mammaplasty

Costal cartilage irregularities are a major component of most congenital thoracic-wall deformities. A significant number of patients with these cartilage irregularities may either refuse major reconstruction or in fact have disorders of insufficient magnitude to justify such endeavors. In patients undergoing augmentation mammaplasty, recontouring or sculpturing of these abnormal costal cartilages may correct or improve the underlying chest-wall deformity and thus enhance the final aesthetic result. This method has had application in mild to moderate asymmetrical cases of both pectus excavatum and pectus carinatum, thoracic hypoplasia (Poland's syndrome), isolated cartilage deformities, and spinal scoliosis. In our hands, the combination of cartilage sculpturing with submuscular augmentation mammaplasty is performed as an outpatient local anesthetic procedure requiring not more than 90 minutes.

Operating room mirror for mammaplasty evaluation.

Patients undergoing augmentation mammaplasty are draped so that they can sit up during the operative procedure. With the help of a mirror, both patient and surgeon can view the new contours with trial prostheses before final closure is made. A more accurate evaluation of the result is gained, and changes can be made immediately.