Round Implants Research Articles

Three-Dimensional Evaluation of Breast Augmentation and the Influence of Anatomic and Round Implants on Operative Breast Shape Changes

Currently, postoperative outcome analysis in breast augmentation is essentially subjective, and objective evaluation of treatment efficacy is lacking. This study evaluates the influence of anatomic and round implant parameters on breast contour changes after subpectoral breast augmentation using three-dimensional (3D) surface imaging. 3D surface breast scans of 17 patients (34 breasts) undergoing subpectoral breast augmentation with round implants and of ten patients (20 breasts) receiving anatomic implants via an axillary approach under endoscopic assistance or a submammary fold incision were obtained before and 6 months postoperatively. 3D linear distance, breast volume, and surface measurement were correlated with the implanted round and anatomic implant parameters, and the resulting breast shape changes were evaluated. Total breast volume changed in correlation with the implant size (2.4% difference; r=0.894; p<0.001). Implant volume and type influence the nipple-to-inframammary fold distance (N-IMF). Every inserted 100 ml implant volume enlarges the N-IMF distance by 0.8 cm (anatomic>round; p=0.01). Postoperatively, the IMF dropped by an average of 1.3 cm for round implants and by 1.1 cm for anatomic implants, without relevant differences between the applied surgical incision and the selected implants (p>0.05). Breast projection increased significantly more with anatomic implants (2.4 cm) than with round implants (1.7 cm) (p=0.01). The breast projection increase was 22% less than expected for round implants and 25% less than expected for anatomic implants based on the manufacturer implant parameters (p<0.01), without essential differences regarding the surgical incision. 3D breast shape changes induced by round and anatomic implants after subpectoral augmentation mammaplasty are objectively documented including breast projection, volume, and N-IMF distance changes. 3D surface imaging may have a potential clinical contribution to objective surgical outcome research. 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 at www.springer.com/00266.

Anatomical versus Round Implants: Discrepancy between What the British Public Prefers and What British Cosmetic Clinics Offer as Standard Implants

Sir: There are a wide variety of techniques and implants available for breast augmentation. Knowledge of preferences and current trends in what is considered a “desirable appearance” can help reach a mutual preoperative consensus and high postoperative satisfaction. Surprisingly, little is known about the British public's perception and preferences. We conducted a street survey on the preferred breast shape among 43 randomly selected Caucasian British women and compared this to what 10 of the largest cosmetic clinics offered as a “standard augmentation.” We wanted to see whether this preference was related to the type of media exposure and whether this differed from 40 (more informed) plastic surgery nurses recruited from our unit. All subjects completed a demographic questionnaire, were asked whether they read scientific journals or magazines, and were asked which postoperative photograph (exhibited on the Web) they preferred. All were shown the same photographs, one with a natural appearance and one with a “pushed-up” appearance. The cosmetic clinics received a blinded telephone inquiry, asking what types of implants they had available and what standard implant they offered. No individual surgeon was approached. Subject ages ranged from younger than 20 years to 60 years. There was an overwhelming preference toward the natural appearance in both groups, 34 members of the public (80 percent) and 35 nurses (87 percent), which did not seem to be influenced by age or media, with 22 members of the public and 20 nurses reading magazines only. Among the nine members of the public (20 percent) and five nurses (13 percent) who preferred the pushed-up appearance, eight and four only read magazines, respectively. In contrast, a larger number of round implants were offered by the clinics. Although all offered both round and shaped implants, six offered round implants as standard procedure, which were less costly. One clinic offered anatomical implants as standard and three clinics did not recommend any preferred implant choice (Table 1).Table 1: Implants Offered by 10 of the Largest Cosmetic Clinics in the United KingdomOur survey gives insight into some factors influencing the British public's preferred appearance. Previous studies have shown that the media and acceptance from society motivate patients to undergo surgery.1,2 However, despite an excessive pushed-up appearance from media exposure, our survey seems to indicate a changing trend in the British public's preference. This change was difficult to establish because there were no previous studies available for comparison. The discrepancy between the preferred appearance and what is currently offered in the British cosmetic sector as the standard implant could be attributable to keeping the cost minimal, lack of experience or training of the “cosmetic surgeon” with anatomical implants, poor patient information, or lack of awareness of available choices. Alternatively, it could be that clinics are slower in moving with change. We recognize that our sample size was small and that the standard offered is not a reflection of each of the surgeons within those clinics. Nevertheless, it gives some indication of the current British public's preference, which may help British surgeons achieve greater patient satisfaction. It would be of interest to compare these findings with similar information for the American and Asian public. Anita A. Liem, F.R.C.S.G.(Plast.) William J. Holmes, M.R.C.S. Azhar Iqbal, F.R.C.S.(Plast.) Department of Plastic and Reconstructive Surgery Whiston Hospital Merseyside, United Kingdom

No Differences in Aesthetic Outcome or Patient Satisfaction between Anatomically Shaped and Round Expandable Implants in Bilateral Breast Reconstructions: A Randomized Study—The Role of the Sample Size Calculation

No Differences in Aesthetic Outcome or Patient Satisfaction between Anatomically Shaped and Round Expandable Implants in Bilateral Breast Reconstructions: A Randomized Study—The Role of the Sample Size Calculation

“Upside-Down” Augmentation Mastopexy

The author's wide experience with postbariatric body contouring pushed him to find a technique suitable for correcting the two most common defects of the massive weight loss (MWL) breast: hypotrophy and ptosis. For these defects, a technique selection algorithm has been created. According to the algorithm, the "upside-down" technique was developed for those cases with a diagnosis of "minor ptosis" (<6cm of vertical nipple-areolar complex correction). The upside-down technique is performed as follows. (1) Complete subcutaneous undermining of the glandular upper pole to the upper edge of the mammary gland is performed. (2) After rotation around the edge, upside-down retroglandular undermining is performed, with great care taken to leave the inframammary fold and 2cm of the gland undetached. (3) Topside-bottom implant insertion is performed with a "mailbox posting" action. The inframammary fold and the undetached gland act as a bra to prevent implant ptosis. The upper one-third of the prosthesis can be placed beneath the pectoralis major muscle with the "dual-plane" technique if a round implant is used or left completely retroglandular if an anatomic implant is used. (4) The type of implant needed (round vs anatomic) basically depends on the type of aesthetic defect. Major upper pole defects need round implants, and major lower pole defects need anatomic implants. The patient's preferences are a primary factor in the decision. (5) Breast lifting is performed through strong anchorage to the fascia, muscle, and second rib periosteum. At least three stitches of threaded nonabsorbable 0 or 1 suture are positioned. The whole lower gland pole is left undetached to guarantee blood perfusion (only 1 or 2cm of periareolar incision are undermined). (6) Periareolar suture is always performed with the "interlocking" technique according to Hammond. From November 2001 to May 2010, 231 patients underwent surgery using the described technique. The patients all were Caucasian with an average age of 38years (range, 31-53years), and all underwent surgery bilaterally. The mean operating time was 150min (range, 120-180min), and the mean hospital stay was 3.5days (range, 2-5days) after surgery. The ptosis recurrence rate was evaluated. A recurrence is identified when the nipple-areola complex slides more than 2cm 1year after surgery. The recurrence rate was 27.6% for other techniques versus 9.1% for the upside-down technique. Natural shape, stable position, and short scars are the main advantages of the upside-down technique. The typical breast flatness after periareolar access is best corrected by the last-generation dual-cohesiveness anatomic implants, which the author strongly recommends to obtain the best results with this technique. The Body Uneasiness Test (BUT) study showed 100% improvement of patient discomfort.

No Differences in Aesthetic Outcome or Patient Satisfaction between Anatomically Shaped and Round Expandable Implants in Bilateral Breast Reconstructions: A Randomized Study

The demand for bilateral mastectomy and immediate breast reconstruction has increased in recent years, primarily due to the development of genetic testing. The aim of this study was to evaluate if there was a difference between anatomically shaped and round permanent expandable implants in one-stage bilateral breast reconstruction after bilateral prophylactic mastectomy. The anatomically shaped permanent expander implant McGhan Style 150 (Inamed, Santa Barbara, Calif.) was compared with the round permanent expander implant Siltex Becker 25 (Mentor, Santa Barbara, Calif.). Thirty-six women who opted for bilateral prophylactic mastectomy and immediate reconstruction with implants from 2004 to 2006 were included and randomly assigned to each group [18 women (36 breasts) per group]. Time to follow-up was a minimum of 2 years after the bilateral prophylactic mastectomy. Implant-related complications, breast symmetry, aesthetic outcome, and patient satisfaction were evaluated. Aesthetic outcome was evaluated by an expert panel that also tried to recognize if the breasts were reconstructed with anatomically shaped or round implants. Patient satisfaction was evaluated by a questionnaire. Average time to follow-up was 30 months (range, 24 to 49 months). There was no statistical difference between the two implant groups in terms of complications, breast symmetry, or outcome scores from the expert panel and patient assessment. The expert panel guessed the right implant shape in 42 percent of the anatomically shaped implants and 66 percent of the round implants. In immediate one-stage breast reconstruction after bilateral prophylactic skin-sparing mastectomy, anatomically shaped and round permanent expander implants had comparable complication rates, aesthetic outcomes, and patient satisfaction after 2 years of follow-up.

Comparative Outcomes of Smooth Versus Textured Round Gel Implants in Primary Breast Augmentation

Comparative Outcomes of Smooth Versus Textured Round Gel Implants in Primary Breast Augmentation

Aesthetic Breast Augmentation and Thoracic Deformities

To ensure the best results from aesthetic breast augmentation, preoperative evaluation and adequate patient information are essential. However, assessment of the underlying thoracic shape often is neglected. Patients with obvious deformities are aware of the problematic reconstruction, whereas patients with mild or moderate deformities often are not aware of their condition and fail to see that standard breast augmentation will lead to unsatisfying results. The authors reviewed their charts for patients with breast augmentation and mild to moderate thoracic deformities, then compiled the therapeutic possibilities and the outcome. Of the 548 patients who underwent breast augmentation, 7.1% (n=39) exhibited low- or midgrade thoracic wall deformities. Almost none of the patients were aware of their deformity. The patients were augmented with silicone-filled, textured round implants. Placement and volume were adapted to the anatomic situation. A reoperation was not performed in any case, and both patient and physician satisfaction was high. The percentage of patients with thoracic deformity in this group was high compared with an overall incidence of less than 2%. This emphasizes the need for cautious physical examination and preoperative documentation. By individualized surgical planning and diligent implant selection, optimal results and patient satisfaction can be achieved.

Round Gel Breast Implants or Anatomic Gel Breast Implants: Which is the Best Choice?

Since their introduction in 1993, anatomic implants have been popularized by numerous surgeons, but very little literature compares the precise indications, advantages, and disadvantages between round implants and anatomic implants. A retrospective analysis was performed for all the patients who underwent breast implantation by the main author over a 15-year period. The number of implanted patients, the shape of the implants placed, the approach routes, and the placement plane were determined as well as the relationship between the shape of the implant and the approach route. The aesthetic results obtained were analyzed in detail based on the shape of the implant used. Over a 15-year period, 932 patients underwent surgery for breast implants. During the first 6 years, only round implants were used, and during the last 9 years, both anatomic and round implants were used. A total of 787 pairs of round implants and 145 pairs of anatomic implants were placed. The indications based on the postoperative aesthetic analysis suggest the use of implants according to their shape. The use of anatomic implants is suggested for patients with significant differences in chest height and width measurements, for cases of significant mammary asymmetry, for patients with a small breast volume or a prominent thorax, and for breasts with a significant deficit of inferior mammary volume or significant shortening of the breast. The authors recommend round implants for patients with a superior pole deficit or moderate breast pseudoptosis, for patients who have a breast that will cover the implant, and for patients who present with a small asymmetry.

Sonographic Criteria for the Confirmation of Implant Rotation and the Development of an Implant-Capsule-Interaction (“Interface”) in Anatomically Formed Textured Breast Implants with Texturised Biocell®-Surface

AIM: In comparison to round breast implants, anatomically formed implants have a broader indi-cation spectrum in augmentation surgery for the formation of a natural breast shape. In order to achieve a long-term result, it is necessary for anatomically formed breast implants to remain secured in the position desired and planned initially. In the case of textured implants of a certain pore size and depth, this can be aided by the development of a stabilising implant-capsule-interaction (interface). The aim of this study was to investigate whether there are sonographic criteria for verifying the -position of anatomically formed breast implants and the development of a stable interface. MATERIAL AND METHODS: 628 patients underwent breast implant surgery and were followed up clinically as well as sonographically at the Frauenklinik und Institut fur Asthetische Chirugie am St. Josefs-Hospital, Wiesbaden. 228 implants (Style 410 Inamed McGhain®) were evaluated after a mean of 27 months postoperatively. Only cosmetic augmentations were included in the -results. Verification of the implant position was conducted by palpation as well as by sonography. Statistical analysis was performed using the McNemar-Test (Chi-squared test). RESULTS: Two marker points on the anterior side of the implant capsule in the lower hemisphere, which are designed for intraoperative position monitoring by palpation, could be reproduced sonographically in all cases and the position of the breast implant could thereby by determined. Two cases of clinically apparent implant rotation of more than 90° around the vertical axis were discovered in this way. The sonographical identification of the development of a stable interface between the implant and the periprosthetic capsule is possible when sonographic criteria of the “parasternal movement layer” are met. The sonographic outcome is significantly superior to palpation. CONCLUSION: Breast sonography used for the clinical follow-up of -patients with anatomically formed breast implants represents an -efficient diagnostic supplement with clinical relevance.

Two-stage breast reconstruction using form-stable, anatomically shaped implants.

Abstract Abstract #4151 Background: Two-stage breast reconstruction using a tissue expander followed by a permanent implant is a reconstruction option offered woman undergoing mastectomy for treatment of breast cancer or for prophylactic mastectomy. Form-stable, anatomically shaped implants can be used as permanent implants and offer more options for shape and size than currently available round implants. The Allergan Inc., Style 410 implant has a matrix of 144 implants with 12 shapes and offer more options for reconstruction in breast cancer patients. These implants are currently available under study protocol in the United States to a limited number of plastic surgeons.&amp;#x2028; Methods: The charts and satisfaction surveys of 104 patients who underwent 2-stage breast reconstruction using Allergan's Style 410 implant were reviewed. All patients had 2-stage breast reconstruction performed with placement of a tissue expander followed by a second stage procedure 3-9 months after the first stage. The authors performed all of the second-stage procedures. Four patients had their first-stage procedure performed by other physicians.&amp;#x2028; Results: A total of 154 breasts were reconstructed. Allergan Style 410 implants were used in all patients at their second stage. Seventy-one patients had an immediate reconstruction; 33 delayed. The patients ranged in age from 24 to 70 years old at the time of their first operation. Follow up ranged from 6 to 80 months. Two patients have been lost to follow up but were followed for at least 2 years postoperatively. There were 11 reoperations in 10 patients: 4 patients required reoperation to a larger size implant after weight gain; 1 patient required exchange to a latissimus flap after exposing her implant after radiation therapy; 2 patients had skin revision after mastectomy; 1 patient had 2 procedures for rotation of the implant; and 2 patients requested removal of their implants because of pain associated with implant rotation. Fifteen patients received radiation therapy postoperatively. Of these patients, 2 had Grade 4 capsular contracture and 2 had Grade 3; the rest had Grade 1 or 2. None of the patients who did not receive radiation had more than a Grade 2 capsule. Seventy-seven patients reported that they were very satisfied with the result of their reconstruction, 22 patients reported they were somewhat satisfied, 1 patient reported being neither satisfied or dissatisfied, and 3 patients reported they were dissatisfied.&amp;#x2028; Conclusion: Anatomically shaped form-stable implants show a high patient satisfaction rate of 95% and low reoperation rate in women undergoing mastectomy and reconstruction. The capsular contracture rate of 2.6% compares favorably to the Inamed Core Gel study presented to the FDA, which showed a capsular contracture rate of 14.1% at 4 years with responsive gel implants. The reoperation rate of 5.8% also compares favorably to the Core Gel study that reported a reoperation rate of 40.9% at 4 years. The rotation rate of the anatomically shaped implants was 2.6%. Further follow up is needed to see if these favorable outcomes remain with time. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4151.

Muscle-Splitting Breast Augmentation: A New Pocket in a Different Plane

Breast augmentation usually is performed in subglandular, subfascial, or partial submuscular pockets, including the dual plane. A new pocket has been described and used by the author. The initial pocket was made in the subglandular plane up to the lower level of the nipple-areolar complex, and the submuscular plane was reached by splitting the pectoralis major muscle without its release from the costal margin. The implant lies in this plane simultaneously behind and in front of the pectoralis. From October 2005 to November 2006, 125 patients underwent bilateral breast augmentation using the new technique. Soft cohesive gel microtextured round implants ranging in size from 230 to 440 ml were used. All the patients experienced a quick recovery with three-dimensional enhancement and having the benefits of both subglandular and submuscular planes. No rippling, lateral displacement, double-bubble deformity, or muscle contraction-associated deformities were seen. All the patients had aesthetically natural cleavage, with the nipple at the most projected part of the breast. Postoperative analgesia requirements were reduced because of dissection in natural planes. For adequate cover of the prosthesis, only the upper part of the pectoralis major muscle is required. This can be achieved by using the pectoralis muscle-splitting technique. The pectoralis major was split in the direction of its fibers, avoiding extensive muscle release. Surgical morbidity was reduced, resulting in a quick postoperative recovery and a more natural three-dimensional appearance of the breast.

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.

Capsular contracture around saline-filled and textured subcutaneously-placed implants in irradiated and non-irradiated breast cancer patients: Five years of monitoring of a prospective trial

One hundred and seven breast cancer patients underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously-placed, round, saline-filled prosthesis with a textured surface. The primary aim of this prospective study was to determine the frequency of capsular contracture in both irradiated and non-irradiated breasts after this operation. Two different types of round implants with different pore sizes on their textured surfaces, Siltex and Microcell, were randomly chosen. Twenty-four patients received radiotherapy within the first year following the operation. Capsular contracture was measured by the Baker/Palmer classification and by applanation tonometry at regular intervals for 5 years or as long as the patients lived (median 60 months). Twenty-two patients (20.6%) developed capsular contracture, defined as Baker three or four. Sixteen of those were reoperated, 15 with open capsulotomy with or without implant exchange, one with closed compression capsulotomy, and monitored thereafter for 5 years or until death (median 60 months). All 107 patients could be monitored for 2 years, while 87 reported for the 5-year follow-up. The rate of capsular contracture was significantly higher (p=0.01) for irradiated breasts than for non-irradiated ones, 41.7 and 14.5%, respectively. It was slightly higher (p<0.05) for large-pore implants than for those with smaller (and more numerous) pores. There was a good correlation between the two different methods for measuring capsular contracture. None of the 16 reoperated patients had a recurrence of capsular contracture within 5 years. The results indicate a high rate of capsular contracture after this operation, especially when followed by radiation. However, a fairly simple procedure to treat capsular contracture seems to give good long-term results.

Prothèses mammaires rondes ou anatomiques. Avantages et inconvénients respectifs

The authors report of their experience of mammary augmentation with anatomical implants from 10 years ago. The important proportion of rotation of those anatomical implants obliged them to stop the clinical serie. Sylvain Staub return to a “revisited” classical technique with round implants, smooth in a majority of cases and placed them most of the time in a retromuscular pocket. Eric Auclair, ceduced by the concept of anatomical implants, decided to continue in this direction with a personal concept of anti rotation system. He shows a strategie of mammary augmentation that favorise the premuscular position and define the respective place of round and anatomical implants.

Analyse descriptive des différents implants mammaires disponibles sur le marché européen en 2005

Laboratories propose a large variety of mammary implants, in which the multiplicity makes it difficult for the surgeons to choose. The objective of this work was to analyze the various features of the implants proposed by manufacturers, in particular the characteristics of the shell, the specificities of the filling, and the morphology of the implants. Nine laboratories sell ten brands of mammary implants on the European market. The laboratories are: Arion, Eurosilicone, Inamed Aesthetics, Mentor, Nagor, Perouse Plastie, Poly Implants Protheses, Polytech Silimed and Sebbin. All laboratories propose smooth or textured surfaces on the shell. Only one laboratory uses a surface covered by micropolyurethane foam. The fillings consist of a saline solution or a silicone gel. One laboratory provides a filling with hydrogel containing carboxymethylcellulose. The forms suggested are round or anatomical. The various models propose a variation on the projection for the round implants and a variation on the height for the anatomical implants. Analysis of the different catalogues makes it possible to underline the lack of precision in the terms of usage, in particular for the description of the form and the texture. It is unfortunate to have very little technical information and no clinical or biological information imposed by the European standard EN 12180. This prevents the surgeon from making his choice according to the real quality of the implants.

Indications and practical applications for high-profile saline breast implants

Background High-profile round saline breast implants that permit a better match of implant diameter to the base diameter of the breast are now available. Objective The advantages and disadvantages of high-profile breast implants are defined from the point of view of the author's initial experience. Methods The maximal optimal breast implant was determined on the basis of preoperative measurements, with emphasis on breast base diameter. Patients selected implant size using trial implants in a bra of the desired cup size. The implant profile with the best match to breast base diameter at the selected size range was used. Results Sixty-seven patients, of a total of 164 patients who received saline breast implants during a 14-month period, received high-profile breast implants. Conclusions High-profile saline implants provide a useful option for the patient who desires an implant size that exceeds the natural breast base diameter in standard profiles. Rippling may be diminished in these cases. A more conical shape may be achieved in cases of periareolar mastopexy with augmentation. Disadvantages of the high-profile design include less mobility of the implant and a less obtuse transition from the chest to the upper breast compared with results achieved with standard round implants.

"Tear-drop augmentation mastopexy": a technique to augment superior pole hollow.

Breast ptosis classification systems focus on the inferior descent of the nipple, as well as the descent and distribution of the breast parenchyma below the inframammary fold. Common problems, such as development of a superior pole hollow and an excessive width of the superior pole, extending into the axilla, are not addressed. Few procedures specifically address these deficiencies, and even less information is available in terms of preventative maneuvers when augmentation is desired as an adjunct. Round implants worsen the problem by creating a superior pole shelf, and anatomic implants are unreliable alternatives. Here, we present a technique-"tear-drop" augmentation mastopexy-that addresses superior pole hollow, excess superior pole width, as well as breast ptosis and hypomastia. Patients with moderate to severe breast ptosis (Regnault's classification), tubular breast deformity, and deformities secondary to previous breast surgery are included in the study. Skin is deepithelialized through a circumareolar incision, and a skin-fat flap is elevated completely encircling the breast. A 2-cm area of parenchyma is left attached to the skin in the lower half of the breast. Breast parenchyma in the superior half of the breast is then advanced and plicated in a superiomedial direction to move the nipple areolar complex to the desired new position. Care is taken to redefine the pectoralis major muscle at its axillary border. A 3-cm incision is then placed in the inferior part of the parenchyma at the 6 o'clock position to create a subpectoral pocket for placement of the implant. The tunnel is then closed to separate the implant pocket from the subcutaneous dissection. Residual dermal flap is used to define, and add durability to the parenchyma reshaping procedure. A 3-0 mersiline (Ethicon, Somerville, NJ) blocking suture is used for a uniform circumareolar skin closure. Patients (n:35), ages 17-48, underwent "tear-drop" augmentation mastopexy between January 1999 and September 2002 for correction of the breast ptosis, tubular breast deformity, and deformities secondary to previous aesthetic breast surgery. The average follow-up was 2 years. All patients displayed type 1 or 2 (Baker classification) capsules. One subcutaneous hematoma and one subcutaneous seroma were seen, which were both treated by percutaneous aspiration. No submuscular hematomas, infections, skin or nipple losses, or hypertrophic scars were noted. Patient satisfaction was high. A more natural "tear-drop" breast shape was created with an improvement in the superior pole hollow and narrowing of the superior breast. The smallest breasts did not benefit from this technique for elimination of the superior pole shelf, as correction was proportional to the amount of breast tissue available for superior advancement. The "tear-drop" augmentation mastopexy is a novel technique for correction of the breast ptosis with augmentation, avoiding problematic development of superior pole hollow and excess superior width. This technique is also well applied to tubular breast deformity as well as to secondary breast procedures. Long-term follow-up demonstrates a safe and reproducible result with high patient satisfaction. This technique may solve several problems associated with breast ptosis surgery, which before were not specifically addressed, and the technique warrants further investigation.

A comparison of naturally shaped and round implants

Background: The relative merits of round versus naturally shaped breast implants continue to be a subject of debate. Objective: The results of augmentations with McGhan Style 110 round textured noncohesive-gel-filled implants were compared with those using McGhan Style 410 FM naturally shaped, textured cohesive-gel-filled implants in 2 similar groups of patients. Methods: Patients in each implant group ranged from 23 to 60 years of age; the average of each group was similar. To ensure continuity of follow-up, only patients from southern Switzerland were chosen for the study. The average implant size in the Style 110 group was 216 cc; the average implant size in the Style 410 group was 232.8 g. All implants were placed in the subglandular position, in front of the muscle. Patients were monitored after operation for a minimum of 4 years. Results were documented photographically from 1 year to a minimum of 4 years after operation. Results: In the Style 410 group, 49 of 50 breasts were normal Baker I, 5 years after operation; 1 breast had become hard without deformation (Baker II). In the Style 110 group, all breasts were normal Baker I, 5 years after operation. On photographic evaluation, it was nearly impossible to distinguish between the 2 types of implants. Conclusion: Excellent results can be achieved with either type of implant. With appropriate placement, the Style 410 matrix can provide the patient who so desires additional options with respect to medial fullness, lateral protrusion, and upper pole filling. (Aesthetic Surg J 2002;22:238-246.)

Breast Augmentation with Full-Height Anatomic Saline Implants: The Pros and Cons

Full-height anatomic implants, like round implants, have advantages and disadvantages. Based on 21 years' experience using round implants and 10 years' experience using anatomic implants, the author believes that anatomically shaped implants offer substantial, significant advantages compared with round implants in more than 90% of primary augmentations. Anatomic implants are a significant addition to the armamentarium of any surgeon who performs primary breast augmentation, provided that the surgeon is willing to meet requirements for optimal use of these more sophisticated products: more stringent implant selection based on individual patient tissue characteristics, accurate pocket dissection under direct visualization, accurate implant positioning based on measured and visual parameters, and above all, detailed patient informed consent about the trade-offs of all implant options. Absent the willingness and skills development to meet these requirements, surgeons should avoid using anatomic implants.

Breast Augmentation with Anatomical Cohesive Gel Implants: The World’s Largest Current Experience

Anatomic cohesive silicone gel implants in breast augmentations require a considerably different technique compared with standard round implants. If the dimensions and proportions of the thorax and breast and thus the prerequisite for different implant shapes are evaluated adequately, this newer technique can lead to highly predictable results with a high degree of patient satisfaction.