Performing Breast Augmentation Research Articles

Breast Augmentation in Swyer Syndrome Patient

Background: The number of breast augmentation in Indonesia has been raised, especially in young women. Women with disorders of sex development (DSD) can be one of our patients that come for breast augmentation. These patients may also have other problems that can lead to serious disease in her later life, such as malignancies which has 30% probability.Patients and Methods: We report one case of female with 46 XY karyotype and normal female phenotype. She appeared to be normal female but did not develop secondary sexual characteristics at puberty with Tanner classi!cation M1P1, did not menstruate, and had streak gonads in ovarian localization. This gonadal dysgenesis syndrome is also called Swyer syndrome.Result: A clinical team consists of plastic surgeons, gynecologist, psychiatrist, geneticist was build to manage our patient comprehensively. We performed breast augmentation, laparoscopic gonadectomy, and psychological support.Summary: Patient with disorder of sex development (DSD) can be one of our patients who come for breast augmentation. One must pay attention to subtle sign leading to DSD patients such as, history of amenorrhea, wide chest and lack of women body curve. Complete evaluation of sexual development is needed before performing breast augmentation.

Infection caused by Lawsonella clevelandensis after breast augmentation with autologous fat grafting: a case report

BackgroundLawsonella clevelandensis is one recently documented anaerobic, which is partially acid-fast. Nevertheless, it is rarely found to be associated with human infections, especially in scope of plastic and cosmetic surgery before our patient who was performed breast augmentation with autologous fat grafting. Breast augmentation is becoming popular, the most common post-surgery complication of which is bacterial infection.Case presentation A 29-year-old female who was found swelling in her right breast and fever after breast augmentation surgery with autologous fat grafting was administered. Before administration, she had been treated with antibiotics (details unknown) for more than 1 month without any significant improvements. After administration, she was treated with intravenous antibiotic empirically and repeated debridement via Vaccuum Sealing Drainage (VSD). And samples of the necrotic tissues and pus collected in surgery were sent for microbiological testing. However, routine examination failed. Thus samples were further collected and sent to Genoxor Medical & Science Technology Inc. (Shanghai, China) to conduct Next-Generation Sequencing (NGS). Surprisingly Lawsonella clevelandensis was determined. Accordingly, sensitive antibiotic was applied in concert with thorough debridement and drainage and finally her condition was completely reversed with wound closure gradually.ConclusionComplications of breast augmentation with autologous fat graft are various, of which infection is most common. Rare pathogen such as Lawsonella clevelandensis infection in human is rare in clinical practice. Moreover, it is difficult to differentiate from non-tuberculous mycobacterium for its partial acid resistance, difficulty to culture and abscess formation. How to determine diagnosis of Lawsonella clevelandensis infection accurately come to be critical In our report, NGS is recommended as a useful method to identify the pathogen, which may provide us a novel tool for refractory wound.

It Is Time to Resolve the Dilemma and Move Away From Using Drains in Primary Breast Augmentation.

Breast augmentation is one of the most commonly performed aesthetic surgical procedures, yet there has been no consensus on the use of drains. While some surgeons believe in using them due to fear of complications or because they were taught in a conventional manner, the authors present their experience of performing breast surgery without the use of drains. To study whether performing breast augmentation without the use of drains is safe. Anthropometric details and complications of all the consecutive primary breast augmentation patients performed by a single surgeon from 2009 to 2022 were collected and analyzed. In none of these patients, drains were used. A total of 429 (21%) patients were lost to follow-up and only those 1617 patients with a minimum follow-up of 6 months were included in this study. The mean age of the study group was 29.8 years with a mean BMI of 24.68. Mean follow-up was 16.24 months. Hematoma occurred in 15 patients (0.92%), seroma in 12 (0.74%), explantation due to infection in 3 patients (0.18%), and capsular contracture in 44 patients (2.72%). All these complications were in the lower range of complications of breast augmentation reported in the literature. Unwarranted use of drains in breast augmentation should be avoided as it does not seemingly prevent the complications of breast augmentation surgery. Instead, it may increase the chances of infection, pain, and discomfort, and prolong the antibiotic coverage, and hence put an additional overall financial burden on the patient.

Breast Augmentation: A Cross-Sectional Survey of UK and Irish Aesthetic Surgeons.

Breast augmentation surgery is the most frequently performed aesthetic surgical procedure within the United Kingdom year on year. However, many variations exist among surgeons regarding various aspects of implant usage and technique. The aim of this study was to evaluate current trends and practices in breast augmentation, within the United Kingdom and correlate them to evidence-based literature. An electronic survey of 41 questions was sent to 201 surgeons performing breast augmentation within the United Kingdom and Republic of Ireland. The survey inquired about the surgeons themselves, their practice, implant choice, surgical technique, post-op care, revision surgery, and impact of breast implant-associated anaplastic large cell lymphoma among several other questions. There were a total of 166 respondents, with 146 completing the survey fully, equaling a response rate of approximately 73%. Overall, there were specific trends in certain aspects such as type of practice, number of augmentations performed per surgeon per year, preferred implant manufacturer, and implant characteristics. That said, there has been a change in other aspects such as implant texture with an increase in the use of smooth implants. The United Kingdom and Ireland concur with certain internationally dominant practice preferences, including the use of inframammary incisions and post-op bra use. This survey suggests that many aspects of breast augmentation surgery in the United Kingdom are approaching standardization. There are, however, some variations in practice and controversies remaining as expected. It is our belief that further standardizing this very common aesthetic surgical procedure according to evidence-based guidelines will help to improve outcomes for patients.

Basic Strategies of Augmentation Mammoplasty in Patients with Tendencies of Pectus Excavatum and Carinatum.

In this era of growing popularity of cosmetic surgeries, more women of various chest wall shapes are likely to receive augmentation mammoplasty. Pectus excavatum (PE) and pectus carinatum (PC) are the two most common chest wall deformities, and many asymptomatic patients visit the clinic. In this study, we presented various strategies for successfully performing breast augmentation in PE and PC patients without long-term complications such as symmastia. From January of 2019 to December of 2021, a total of 132 patients with tendencies of PE and PC received augmentation mammoplasty in our institute. We retrospectively reviewed data on demographics, surgical procedure, outcomes, and complications. Among the 132 cases, 71.21% were done via inframammary approach, and 28.79% via transaxillary approach. The mean implant volume was 337.25 ± 51.46 ml, and the mean follow-up period was 16.48 ± 6.74 months. The Likert scale of outcome satisfaction scored 9.13 ± 0.48. No symmastia occurred. We presented our basic strategies of breast surgery in patients with various chest wall anomalies. Augmentation mammoplasty can benefit PE and PC patients physically as well as psychologically, to carry out healthy positive lives. 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 .

Surgical practices of cosmetic breast augmentation by implants among 411 French plastic surgeons

Breast augmentation is one of the most frequently performed cosmetic surgeries in the world. However, there is no standardized surgical procedure for performing breast augmentation. Many modalities exist for this surgery which may explain why practices vary greatly from one surgeon to another. The aim of this study was to evaluate current practices of breast augmentation by implant in France and changes in practices among French plastic surgeons.This observational study was conducted between February 2020 and January 2021. An online questionnaire with 62 questions was sent to 729 French plastic surgeons. The questions concerned: the population of surgeons interviewed, pre-operative aspects, surgical technique and post-operative management.411 plastic surgeons responded, 5.1% of surgeons impose a nicotine screening test on patients. 99.76% and 95.59% reported that they used silicone gel implants and round prostheses. All used smooth or micro-textured shells. The inframammary approach was the most used by 66.2% of plastic surgeons. The implants placed were between 250 and 300 cc on average and were mainly placed in "Dual plane" by 42% of surgeons. In order to reduce bacterial contamination, 26% of surgeons soaked the implants in a povidone-iodine solution and 23% used an insertion sleeve. The most frequent early complication was hematoma, while capsular contracture was a late complication.This study provides new data on current surgical practices of breast augmentation in France, allowing more informed choices and opening up perspectives for more standardized practices in the future.

Current Challenges in Breast Implantation.

Breast implantation (BI) is the most common plastic surgery worldwide performed among women. Generally, BI is performed both in aesthetic and oncoplastic procedures. Recently, the prevalence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) or breast implant illness (BII) has aroused concerns. As a result, several countries, like Australia, Korea or the United Kingdom, introduced national registries dedicated to the safety and quality of BI surgeries. This narrative review aimed to focus on the clinical challenges, management and the current state of knowledge of BI. Both short and long-term outcomes of BI are determined by various alternatives and differences, which surgeons must consider during the planning and performing breast augmentation along with further complications or risk of reoperation. Proper preoperative decisions and aspects of surgical technique emerged to be equally important. The number of performed breast reconstructions is increasing, providing the finest aesthetic results and improving patient’s quality of life. Choice of prosthesis varies according to individual preferences and anatomical variables. A newly diagnosed cases of BIA-ALCL with lacking data on prevention, diagnosis, and treatment are placing it as a compelling medical challenge. Similarly, BII remains one of the most controversial subjects in reconstructive breast surgery due to unspecified diagnostic procedures, and recommendations.

Menstrual Cycle-Related Fluctuations in Breast Volume Measured Using Three-Dimensional Imaging: Implications for Volumetric Evaluation in Breast Augmentation.

Breast volume is a key parameter of breast measurement in breast augmentation. However, the correlation between menstrual cycle phases and variation in breast volume has not been well studied. Young female patients with regular menstrual cycles underwent eight three-dimensional imaging scans during a single menstrual cycle from November 2017 to January 2018. Breast volumetric difference at each timepoint and basic breast volume were measured for each subject. Preovulatory phase and postovulatory phase values were compared using an unpaired t test. A Pearson's linear correlated analysis was performed to identify the correlation between the basic breast volume and maximum range of breast volumetric difference during the menstrual cycle. Thirteen patients (26 breasts) met the inclusion criteria. During the menstrual cycle, the breast volumetric difference showed first a rising trend followed by a fall. A significant difference in the breast volumetric difference between the preovulatory phase and postovulatory phase (-19.6 ± 2.1ml pre-ovulation vs. -6.9 ± 3.3ml post-ovulation, p = 0.002) was noted. There was a positive linear association between breast volume and maximum range of breast volumetric difference when a Pearson correlation was used (r = 0.45, p = 0.021). The breast volume fluctuates during the menstrual cycle, and there is a significant difference between the preovulatory phase and postovulatory phase for breast volumetric change. The influence of the menstrual cycle on breast volume should be taken into consideration by plastic surgeons performing 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 www.springer.com/00266 .

Sub-muscular Breast Augmentation Using Tumescent Local Anesthesia.

Tumescent local anesthesia (TLA) consists of infiltration of saline solution with lidocaine and epinephrine into the tissues to obtain regional anesthesia and vasoconstriction. The use of TLA in augmentation mammoplasty has been described for sub-glandular positioning. We describe a modified TLA technique for primary sub-muscular breast augmentation reporting our experience during the past 7years. From 2010 to 2017, 300 patients underwent bilateral primary sub-muscular breast augmentation under TLA and conscious sedation. The tumescent solution was prepared with 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. Firstly, the solution was infiltrated between the pectoral fascia and the mammary gland, secondarily, during surgery, under the pectoralis major muscle. The average amount of tumescent solution infiltrated while performing TLA was 740mL per breast. No signs of adrenaline or lidocaine toxicity were reported and conversion to general anesthesia was never required. In all patients, no pain nor discomfort was reported during the pre-operating infiltration and surgical procedure. We reported a major complication rate of 3.3% (4 hematomas and 6 seromas) and a minor complication rate of 6.0% (8 implant dislocation and 10 dystrophic scars formation). TLA represents a safe and efficacious technique for performing breast augmentation surgery with sub-muscular implant positioning. This technique guarantees good pain control during and after surgery and has low incidence of postoperative side effects. Patients subjected to sub-muscular breast augmentation with TLA were satisfied. 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 Subtleties of Success in Simultaneous Augmentation-Mastopexy.

Many have challenged the safety of performing breast augmentation and mastopexy simultaneously. However, staging these procedures incurs the increased risk and inconvenience of two periods of anesthesia and recuperation. The authors set out to evaluate the occurrence of complications across the populations of patients undergoing (1) combined augmentation-mastopexy, (2) isolated augmentation, and (3) isolated mastopexy. A retrospective analysis of one surgeon's consecutive series of each of these procedures from 2000 to 2009 was conducted. Preoperative risk factors were characterized. Sixteen different complications were examined, and those necessitating operative revision were tracked. Statistical analysis was performed looking for significant differences between the surgical groups. No instances of infection, tissue loss, or implant exposure occurred among the 297 patients over an average follow-up period of 15.5 months. The isolated mastopexy group did not provide sufficient data for statistical comparison. Tissue-related complications were most common in the combined procedure group. The operative revision rate for isolated augmentation was 7.97 percent compared with a combined procedure revision rate of 12.4 percent (p = 0.28). The majority of complications in this series comparing simultaneous augmentation-mastopexy to isolated augmentation were minor. Complications requiring operative revision were not found to be significantly different between the two groups. There was a much lower reoperation rate (12.4 percent) with the combined procedure compared with a 100 percent reoperation rate when the procedure is staged. Thus, the authors feel the combined procedure can safely be part of every plastic surgeon's practice. Therapeutic, III.

“Slip sliding” technique. A new method to perform mastopexy-augmentation

Background When performing breast augmentation in patients affected by mild-moderate ptosis or pseudoptosis, the plastic surgeon often has to choose whether to perform a glandular mastopexy or not. This decision is controversial not only due to the residual scarring, but also breast reshaping with potential asymmetries, often poorly tolerated or directly rejected by the patient herself.

The Influence of Career Stage, Practice Type and Location, and Physician's Sex on Surgical Practices Among Board-Certified Plastic Surgeons Performing Breast Augmentation

The Influence of Career Stage, Practice Type and Location, and Physician's Sex on Surgical Practices Among Board-Certified Plastic Surgeons Performing Breast Augmentation

Minimizing Capsular Contracture in a “Clean-Contaminated Site”

I read with interest the excellent article by Bartsich et al1 in the September issue of Aesthetic Surgery Journal . The research methods were outstanding, and I congratulate the authors on an important contribution to outcomes in breast augmentation. The data presented confirm other published findings regarding cultures of ductal fluid at the time of breast surgery and also provide a good follow-up to my own article (published in 2008) regarding the relationship of capsular contracture (CC) to incision location in breast augmentation.2 As we have all seen when performing breast augmentation through a periareolar incision, there are times when milky fluid is noted in the operative field as the breast tissue is dissected. It is anatomically obvious that a periareolar incision (as compared to an inframammary incision) will transect many more ducts, and larger-diameter ducts closer to the external environment have a much greater likelihood of harboring bacterial colonies. Since …

Postaugmentation Galactocele

Galactorrhea and galactoceles are relatively uncommon complications after breast augmentation surgery, but should be considered in the differential of an enlarged breast. We present a case of a 34-year-old woman who had a remote history of bilateral breast augmentation and developed a unilateral galactocele while breast-feeding. She subsequently underwent an incision and drainage, as well as medical management with bromocriptine. Her galactocele resolved adequately with this treatment. Surgeons performing breast augmentation should be aware of the clinical presentation as well as the treatment options for this entity.

The Influence of Career Stage, Practice Type and Location, and Physician’s Sex on Surgical Practices Among Board-Certified Plastic Surgeons Performing Breast Augmentation

Breast augmentation is the most commonly performed cosmetic surgical procedure in the United States, but surgeon preferences in terms of technique and postoperative care regimen vary widely. The authors investigated the influence of career stage, practice type and location, and physician's sex on surgical technique preferences among board-certified plastic surgeons performing breast augmentation. In October 2009, an online survey was e-mailed to all active members of the American Society of Plastic Surgeons practicing within the United States. Response frequencies were calculated and correlated with surgeon demographics. From the pool of 4737 respondents, 898 responses were received (18.9%). Surgeons performing breast augmentation were more frequently male, between 46 and 65 years old, and had practiced for at least 20 years in solo private practice in a suburban setting. Surgical volume most frequently consisted of 10% to 25% cosmetic surgery, with 10 to 50 breast augmentations performed per year. Surgeons in practice for five years or less were more likely to use smooth, round silicone gel-filled implants, to select implants smaller than 300 cc, to use the dual-plane pocket, and to recommend yearly follow-up. Surgeons in practice for more than 20 years were more likely to select saline implants, utilize the subglandular plane, perform closed capsulotomy, and place drains. Surgeons at academic centers performed fewer breast augmentation surgeries and placed smaller implants than those in private practice, while surgeons in suburban locations performed more breast augmentations than those in urban or rural locations. Surgeons in the West performed the greatest number of augmentations, although the largest-sized implants were placed in the Southwest. Compared with men, women surgeons appeared significantly less likely to use saline implants, were less likely to perform more than 100 breast augmentations per year, and were significantly more likely to place implants less than 300 cc. Surgical preferences were associated with years in practice and included differences in technique and postoperative care. Practice location was associated with differences in procedural volume, implant size, incision location, and recommended follow-up time, while practice type was related to surgical volume, implant size, implant location, and percentage of cosmetic surgery performed.

P03-506 - Augmentation mammoplasty and sexuality

The interest in breasts in our society can hardly escape the attention of even a casual observer. It has been found that women with larger breasts than the average were considered to be more physically attractive and have greater social outcomes.Some women consider themselves less beautiful or feminine because of the lack of “ideal” size and shape. This feeling of inadequacy may lead to lowered levels of self-esteem and sexuality.Although not extensively researched, psychologic factors have attributed to the dramatic increase in the number of performed breast augmentation procedures. As this number continues to rise it is important that healthcare providers comprehend the degree to sexuality may affect their patients’ outcomes.This review is designed to provide an overview of the psychological and sexuality literature on cosmetic breast augmentation. It seems to exist a positive effect of breast augmentation surgery on woman's sexuality, as well in other psychological aspects. This relation need to be explored further in future studies.

Augmentation Mammaplasty in Asian Women

With the rapid economic development of Southeast Asia, the demand for cosmetic surgery has increased rapidly. Breast augmentation is among the most frequently performed cosmetic procedures. However, breast augmentation still has "bad press" in Southeast Asia because of not so distant catastrophes caused by direct liquid silicone injection and "Amazing Gel" augmentations. Asian patients have special characteristics that need to be taken into consideration when performing breast augmentation. The patients are usually thin and small with proportionally smaller breasts. The areola is often small with a large nipple. Because of poor scar healing, incisions need to be hidden. The transaxillary approach is therefore favored. A frequently performed adjunctive procedure is nipple reduction. In this article, the authors present their preferred technique for augmentation mammaplasty: endoscopically assisted subpectoral placement of smooth saline-filled implants via a transaxillary approach. Simultaneously, nipple reduction with the "modified top-hat flap" procedure is presented. Complications and their management are also discussed.

Effect of Breast Augmentation Mammoplasty on Self-Esteem and Sexuality

Although not extensively researched, psychologic factors have attributed to the growing number of performed breast augmentation procedures. The reported a 293% increase in the cases of cosmetic surgery since 1997. The percent increase in breast augmentation procedures performed in 2003 was up 12 (280 procedures up to 401). As the number of women seeking breast augmentation surgery continues to rise, an increasing number of healthcare professionals are likely to be confronted with questions, concerns, and complications that often accompany the procedure. Consequently, it is important that healthcare providers comprehend the degree to which self-esteem and/or sexuality may affect their patients' outcomes. Healthcare professionals must ascertain specific nursing skills and attitudes while caring for the cosmetic surgical patient. Therefore, the purpose of this research is to gain an understanding of the changes that occur in the levels of self-esteem and sexuality following the breast augmentation. Test of the study hypotheses 1 through 4 failed to be rejected, thereby supporting significant positive relationships between the variables. Statistical analysis of Hypothesis 5 found positive significance between breast augmentation, self-esteem, and the demographic variables-educational level and history of previous cosmetic surgery.

Comparative double blind clinical study on round versus shaped cohesive gel implants

Highly cohesive round or shaped implants are used today by most plastic surgeons performing breast augmentation outside North America. This study was conducted to (1) compare aesthetic outcomes of round versus shaped implants in breast augmentation by defining the preferences of the general female population and plastic surgeons towards two groups of augmented breasts (implanted with either round or shaped devices); and (2) to determine whether or not plastic surgeons could identify the type of implant used in each patient based on the postoperative appearance. The study surveyed 30 breast augmentation patients, 15 with shaped implants and 15 with round devices. Two cohort categories evaluated the postoperative photographs of the patients: the first group comprised 235 female lay respondents and the second group included 11 male plastic surgeons. The lay respondents were asked to score breast beauty and naturalness, and to assess the upper pole. The plastic surgeons were asked similar questions and were additionally asked to try to identify the implant type. With respect to "breast beauty," both respondent categories scored round and shaped implant patients similarly. With regard to "naturalness," both groups scored round implant patients significantly higher (P < .001). Concerning upper pole assessment, the round implant group was scored higher and better than the shaped implant group (P < .001). The plastic surgeons' correct identification rate was 64% for round implants, and 47% for shaped implants. We believe that in the hands of an experienced surgeon who takes all soft tissue variables into consideration, the aesthetic result may not be differentiable when using round versus shaped implants in well-selected patients.

Pneumothorax as a Complication of Breast Augmentation

Pneumothorax is a recognized complication of breast augmentation which, until now, was thought to be rare. The authors hypothesize that it is more common than generally appreciated. A fax survey was sent to 363 members of the California Society of Plastic Surgeons in 2001, questioning their experience with this complication. The survey response rate was 50 percent, revealing that one in three members of the California Society of Plastic Surgeons had at least one patient who experienced a pneumothorax, and one in 10 had experienced two or more complications of pneumothorax while performing breast augmentation. Sixty-two members reported a total of 83 separate pneumothoraces in their career. No local or hypodermic needle injections were used in 24 percent of these patients. Fifty-five percent of patients were hospitalized, with 71 percent of the cases paid for by insurance companies. Treatment consisted of observation and repeated chest radiograph in 33 percent, needle aspiration alone in 16 percent, and chest tube insertion in 47 percent. The cause is difficult to determine, but causes suspected by respondents included intraoperative laceration of the pleura (43 percent), needle puncture at the time of local injection (37 percent), ruptured pulmonary blebs during or after the procedure (16 percent), and high anesthetic ventilation pressures (3 percent). The authors believe the complication of pneumothorax is more common than generally appreciated and is not necessarily caused by negligence. The authors now include this complication in their consent form and recommend keeping an intracatheter, pigtail catheter, or Heimlich valve in surgical facilities for treatment of a possible tension pneumothorax.