Secondary Breast Augmentation Research Articles

Secondary Breast Augmentation: The Six Winning Moves.

Breast augmentation in 2019 was the first among the top five cosmetic surgical procedures performed worldwide, according to the International Society of Aesthetic Plastic Surgery. It is not only the most commonly performed cosmetic surgery, but also the aesthetic procedure with the highest reoperation rate. A retrospective observational study of 306 female patients who underwent secondary breast surgery, with a follow-up of at least 1 year after surgery, from 2010 to 2020 is presented. For patients'selection, we decided to include all patients who performed a secondary breast surgery for aesthetic reasons; only patients with history of previous radiotherapy were excluded. Patients were divided into different groups according to the performed procedure (the six winning moves) and associated postoperative outcomes are shown. The aim of this paper, based on authors' own experience, is to present a personalized approach to secondary breast reshaping, describing the six "winning" moves to apply, which, differently combined among each other, intend to address each specific cause of reintervention with a dedicated surgical procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Subfascial Transaxillary Approach in Primary and Secondary Breast Augmentation: An Update and Critical Evaluation of a 25-Year Review of 1015 Consecutive Cases.

Assess outcomes from the SF TAA technique in a large series of patients who underwent primary and secondary BA. A retrospective cohort of patients who underwent BA between 1999 and 2024 was identified. The primary outcome was occurrence of incision and implant/pocket complications. Regression logistic analysis evaluated risk factors including age, BMI, smoking, implant surface/volume, and fat grafting. The cohort contained 1015 patients (mean age: 28.5±7.3 years) and average follow-up was 77.6±38.6 months. In primary BA, 212 patients (23.4%) experienced at least one complication, most frequently capsular contracture. More complications were seen in secondary BA (p=0.016). Multivariate regression identified BMI<18.5 kg/m 2 as a significant risk factor for incision complications, while textured surface (OR: 2.70; p<0.001) and implant volume >350 cc (OR:2.79; p<0.001) were risk factors for implant/pocket complications. Despite extensive research on BA procedures, studies on SF TAA procedures are limited and have not analyzed long-term outcomes following primary/reoperative surgeries. Our results demonstrate that SF TAA is a reliable technique, and our data are compatible with other studies using different BA approaches. Knowledge of the axillary and pectoralis fascia anatomy allows surgeons to safely implement the SF TAA technique while minimizing risk.

A clinical case of secondary breast augmentation after previous implants removal

The patient underwent primary breast augmentation at a different clinic. Two years later, the implants were replaced with larger breast implants (500 ml each). Three months after the procedure, inflammation of the right and left mammary glands occurred, which led to the removal of both implants. The patient was 24 years old when the surgery took place. She underwent a preoperative examination in accordance with the standards set by the Ministry of Health of Ukraine. The patient came to us for breast augmentation, correction of mammary gland contour imperfections, and management of postoperative scars. Round‑shaped and moderate‑profile implants were selected. Implant parameters: width 13 cm, projection 4.4 cm, implant texture — microtexture, volume 400 ml. We placed the implants in the retropectoral space, and used the dual‑plane method for cavity formation. The surgical procedure lasted for a total of 140 minutes. The duration of the patient’s hospitalisation was one day. No drains were used. The scars on the abdomen were also corrected and fixed in the projection of the inframammary fold. No complications occurred in the postoperative period. The patient received antibiotic therapy and took nonsteroidal anti‑inflammatory drugs. Postoperative wound management was carried out. We prescribed compression underwear for the patient to wear for two months after surgery. Mammoplasty is a commonly performed procedure in plastic surgery. It aims to produce predictable and agreed‑upon aesthetic outcomes for the patient while maintaining a low rate of complications by adhering to modern surgical standards. The patient experienced complications that led to a significant scarring process. The pectoralis major muscle had a significant deformity, and the tissue showed scarring. The lack of muscle elasticity complicated the implant placement, leading to specific challenges throughout the operation. The occurence of complications following mammoplasty invariably has a lasting impact on the capsule’s formation and increases the risk of developing both early and late postoperative issues.

“Intramuscular Breast Augmentation in Secondary Mastopexy Augmentation.”

Background: Breast augmentation with implants is one of the most performed aesthetic surgical procedures performed worldwide. We describe this new option for breast implant secondary procedures, the intra pectoralis major pocket, as a feasible and reproducible surgical technique. Methods: A retrospective chart review was conducted on all patients who underwent revision augmentation or mastopexy augmentation procedure between 2005 and 2022 by the senior author. The intramuscular pocket is dissected between the pectoral muscle fascicles where almost is not bleeding. Results: Patients were followed for an average of 21.5 months. A total of 319 patients underwent revisionary breast augmentation/mastopexies performed by the senior author. Indications for reoperation were based both on specific patient dissatisfaction with their original surgery and surgeon’s physical examination and assessment. In 196 cases we performed the intramuscular pocket. None of the intramuscular had capsular contracture or animation deformity in the follow up period. Conclusions: The intramuscular technique is a valuable and safe technique for secondary breast augmentation.

Rib Reduction Technique in Patients with Isolated Chondrocostal Chest Wall Prominence Undergoing Breast Augmentation.

When planning for breast augmentation, it is important to consider not only implant choice, surgical technique and patient desires, but also the chest wall shape and deformities or irregularities, which remain often underestimated. They can be responsible for implant malposition and breast asymmetry after augmentation. Chondrocostal junction prominence is a minor but frequent chest wall deformity. The aim of this study is to report a new technique for sculpturing isolated chondrocostal prominence deformities in patients undergoing breast augmentation. A retrospective study was conducted to review surgical outcomes of a novel technique for costal prominence sculpturing and reshaping in patients undergoing breast augmentation. After reaching the subpectoral space, an inferiorly-based perichondral-periosteal flap is harvested just above the prominence. Once the deformity is corrected, the perichondral flap is repositioned over the sculpted rib. A total of six patients presenting with isolated chondrocostal prominence underwent bilateral breast implant placement and costal reduction using the described technique. Three patients were primary augmentations while the remaining patients were two secondary breast augmentation and one augmentation mastopexy. No complications were reported. No additional pain was referred at the side of rib remodelling in comparison with the contralateral breast. All the patients were satisfied with cosmetic results. The described technique for contouring of isolated chondrocostal deformities is fast, easy reproducible and offers advantages over the standard partial rib reduction technique. It can prevent implant malposition and projection asymmetry, eventually enhancing breast augmentation outcomes. 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 Role of Antibiotic Prophylaxis in Primary and Secondary Implant-Based Breast Augmentation: A Systematic Review and Meta-Analysis.

The administration of antibiotic prophylaxis for implant-based breast augmentation (IBBA) is commonplace among many plastic surgeons. However, the current literature lacks evidence-based recommendations to support this practice. Although few studies have demonstrated a reduction in surgical site infection (SSI) and capsular contracture (CC) with antibiotics, these studies were underpowered and poorly designed. The aim of this study was to provide an updated comprehensive analysis of the literature to revisit the benefit of antibiotic prophylaxis. A comprehensive literature search of PubMed, Embase, Web of Science, and Cochrane was performed from January 1989 to January 2022. Observational studies and randomized controlled trials (RCTs) involving primary and secondary IBBA and use of antibiotic prophylaxis were included. Primary outcomes included SSI and CC. Study quality and risk of bias were evaluated using standardized tools. A meta-analysis was performed for eligible studies. Trial Sequential Analysis was used to assess the need for future RCTs. A total of 5 studies (3 observational and 2 RCTs) with 2383 patients were included in this study. Rates of SSI ranged from 0% to 2.3%, whereas CC ranged from 0% to 53%. Antibiotic prophylaxis showed no benefit for both SSI (odds ratio, 1.77; 95% confidence interval, 0.76-4.13) and CC (odds ratio, 0.46; 95% confidence interval, 0.00-45.72). Trial Sequential Analysis demonstrated that further high-quality RCTs are needed. Antibiotic prophylaxis for IBBA failed to demonstrate improvements in SSI and CC in this comprehensive review. Current evidence was shown to be of low quality because of heterogeneity and high risk for bias. Further high-quality multicentered RCTs are warranted to fully evaluate the role of antibiotic prophylaxis for IBBA.

Single-Institution Early Experience With a New, Smooth, Opaque, and Round Breast Implant Over a 2-Year Period.

The ideal breast implant does not exist and the choice of implant for breast augmentation is largely based on what surgeons think will be best for their patients. To evaluate the preliminary results of a new, smooth, round, and opaque breast implant (PERLE, GC Aesthetics; Dublin, Ireland) from a single-center UK aesthetic practice. Retrospective cohort study of all patients undergoing breast implant surgery with PERLE at the authors' center between January 2021 and December 2022. Outcomes data such as rates of capsular contracture, infection, revision surgery, and synchronous mastopexy were analyzed. Of the 385 patients identified, 374 (97.1%) had PERLE implants placed by 3 surgeons for primary (n = 290) and secondary breast augmentation (n = 21), and augmentation-mastopexy (n = 63). Capsular contracture occurred in no cases, infection in 1 (0.2%), and revision surgery in 21 patients (5%). The incision used was always submammary, unless a synchronous mastopexy was performed; implants were placed in the subglandular/subfascial plane in the majority of cases (85.3%), and the rest were dual plane (14.7%). Eight revisions were performed in patients undergoing breast augmentation (due to implant displacement in 6 patients, and hematoma and infection in 1 patient each). Fourteen revisions were performed in those undergoing augmentation-mastopexy. The average follow-up time was 18 months. The authors' early, single-center experience with PERLE implants suggests a safety profile and overall complication rate that is comparable with other modern implants. They will continue to monitor the safety and effectiveness of PERLE and discuss the reasons and evolution in the choice of breast implant.

Modified Delphi Technique to Identify Management of Aesthetic Breast Augmentation: Will We Reach a Consensus?

Breast augmentation is a common operation. Evidence has grown with experience and long-term studies, but variation in practice exists. The authors detail the existing practices of a group of surgeons for primary and secondary aesthetic breast augmentation. Seventy-two plastic surgeons with a specialist interest in aesthetic breast surgery were asked to participate in the survey about aesthetic breast augmentation. A 54-point online survey was given, covering demographics about the surgeon and practice, implant choice and perioperative technique, use of emerging evidence and surgical techniques, preferences about secondary surgery, and opinions about topics of controversy. All 72 surgeons completed the survey. Their mean age was 57.6 years, 56.9% had been in surgical practice for over 20 years, and 88.9% were performing more than 50 primary breast augmentations per year. The most commonly used measurement for implant selection was breast width, the most common implant type was silicone (81.9%), and volume range was 250 to 350 cc (86.1%). A total of 36.1% of surgeons use anatomic implants in more than half of their cases. Opinions were divided about postoperative return to work, use of insertion funnel, and acellular dermal matrix. Multiple factors affect clinical outcome in primary and secondary aesthetic breast surgery. A few well-established techniques have gained common acceptance, but opinions are more diverse for difficult, complicated, or challenging scenarios. This survey helps clarify the decision-making process of expert surgeons with an interest in aesthetic breast surgery.

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

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

The Periareolar Approach: All Seasons Technique for Multiple Breast Conditions.

Background:The periareolar approach was first introduced by Hollander in 1924 and, since then, numerous contributions have been reported by different authors. Despite all the strengths associated with this versatile technique, the periareolar approach still poses three main problems: large areolar diameter with poor quality scar, flattening of the breast cone, and poor stability of the results. The purpose of this article is to show how this surgical technique, with a good patient selection, can be applied to different situations and obtain excellent results.Methods:We performed a retrospective study on 5028 consecutive procedures in 4198 female patients treated with a periareolar approach in two regional institutions between 2008 and 2018. We considered 853 pure mastopexies, 362 breast augmentations, 422 secondary breast augmentations, 402 corrections of stenotic breast, 2921 oncoplastic surgeries, and 68 breast reductions. Postoperative complication, as well as patient and surgeon satisfaction were assessed.Result:Patient and surgeon satisfaction 1 year after the procedure was excellent, and the complication rate was low.Conclusions:When the indication is set correctly, the periareolar approach can obtain excellent results. This versatile technique, initially introduced as a mastopexy technique, has expanded its applications and can now be used for multiple surgical situations.

Muscle-Splitting Transaxillary Revision Breast Augmentation-A Single Surgeon's Experience.

Well discussed in a previous article published by the senior author, primary transaxillary breast augmentation drawbacks include the need to correct complications arising from reuse of the axillary incision which the literature is sparse on. We here discuss a technique in patients who underwent a secondary transaxillary breast augmentation procedure. This study aims to present a technique for transaxillary revision breast augmentation with conversion to a muscle-splitting plane which has the advantage of good upper and medial pole coverage and adequate lower pole expansion. We performed a retrospective chart review of 41 women with previous silicone gel implants placed through a transaxillary incision who presented with rippling or a desire for larger implants (January 2016-July 2020). Inclusion criteria were age 18 years or older and having undergone breast augmentation surgery. Exclusion criteria were active smoking and body mass index (BMI) greater than 30 kg/m2. At one year postoperatively patients were asked a "yes or no" question regarding satisfaction with the overall result and with the scar quality. A total of 41 patients were included in this study; no patients were excluded. The patients' age ranged from 32 to 47 years, the average being 38 years old. All participants were female. Mean BMI was 21.9 kg/m2 and all patients had a pinch test <2cm. Indications for surgery included rippling (all patients) and a desire for larger implant size (n = 5). Size of new implants ranged from 325cc to 430cc; all were of a larger size than those used in the primary surgery. Operative time was on average 53 min. [4483 min.]. Mean follow-up was 13 months, ranging from 12 to 15 months. There was no additional cost related to operative time. Regarding patient satisfaction, 100% replied they were pleased with the overall results and scar quality. There were no major complications. The transaxillary approach for muscle splitting breast augmentation revision surgery offers a safe and reproducible technique. Despite having a mean follow-up of only 13 months, we demonstrate a low rate of complication as well as high degree of patient satisfaction with no extra cost when compared to other techniques. 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 .

Secondary Revision of Breast Augmentation (Capsular Contracture)

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success. This review contains 3 figures, 6 tables, 31 references Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation

Commentary on: Reoperative Transaxillary Approach Algorithm: Extending the Surgical Alternatives for Secondary Breast Augmentation in the Era of Scarless Surgery.

Commentary on: Reoperative Transaxillary Approach Algorithm: Extending the Surgical Alternatives for Secondary Breast Augmentation in the Era of Scarless Surgery.

Commentary on: Secondary Composite Breast Augmentation: Concept and Outcomes, Introduction to a Layered Approach.

Commentary on: Secondary Composite Breast Augmentation: Concept and Outcomes, Introduction to a Layered Approach.

Reoperative Transaxillary Approach Algorithm: Extending the Surgical Alternatives for Secondary Breast Augmentation in the Era of Scarless Surgery.

Although the transaxillary approach (TAA) is useful in primary breast augmentation (BA) surgery, drawbacks of this technique include the need to correct complications arising from reuse of the axillary incision. The purpose of this study was to assess the outcomes of secondary BA procedures performed via the TAA in a cohort of patients operated on by a single surgeon and to provide an algorithm for reoperative TAA technique selection. Sixty-two patients (122 breasts) underwent secondary TAA BA, which was indicated for capsular contracture (CC) in 35 patients (56.4%). Periods for analysis included less than 10 days, 1, 3, 6, and 12 months, and then at 2-year intervals postprocedure. Forty-three patients (69.3%) had a previous premuscular (PM) pocket; in 35 (81.3%) of these patients the new pocket was kept in the same position. Nineteen patients (30.7%) had a previous submuscular pocket, and 15 patients (78.9%) had the new pocket transferred to the PM plane. Ten cases of complications were observed in 8 patients (16.1%), Baker grade II/III CC in 3 (4.8%), and axillary banding in 2 (3.2%), during a mean follow-up of 72 months (range, 6-170 months). Fifty-nine patients (95.1%) were either very satisfied or satisfied with their aesthetic result. Recent progress in surgical techniques has led to significant improvements in aesthetic outcomes following BA. The TAA can play a useful role in secondary BA cases and our results show this procedure to be useful, with acceptable complication rates, and the added bonus of avoiding additional scarring on the breast.

Secondary Composite Breast Augmentation: Concept and Outcomes, Introduction to a Layered Approach.

Secondary procedures following breast augmentation are often more difficult than primary cases because the soft-tissue envelope changes over time. This study was conducted to confirm the utility of a composite technique in breast revisional surgery. This was a 9-year retrospective chart and photographic data study of one surgeon's experience with the combined use of fat and implants in revisional cases. The 148 patients had a follow-up at least 1 year after surgery. Our approach consists of a detailed analysis of the different layers covering the implant and yields a treatment plan addressing all issues involving the secondary breast. On average, revisional surgery was performed 8.66 years after the first augmentation. The mean age of the patients at revision surgery was 42 years (range, 22.2-70.7 years). The mean fat harvest was 600 mL (range, 100-3000 mL) and the mean volume of fat reinjected was 153 mL (range, 60-400 mL). The mean volume before and after revision was the same (288 mL vs 289 mL). At the original surgery, the breast implants were located in a subpectoral pocket in 78.7% of the patients and, at the revision surgery, in a subglandular pocket in 74.8% of the patients. Within the first 2 years, 13 patients (8.7%) underwent reoperation for additional fat grafting. Among 45 preoperative breast capsular contractures, there were 8 recurrences in the first 3 years resulting in 4 reoperations. Secondary breast augmentation cannot rely solely on implant exchange. Because the soft-tissue envelope also ages over time, fat grafting is mandatory in the vast majority of secondary cases. A rigorous preoperative analysis enables breast defects to be treated appropriately.

The New Method of Pocket Forming for Breast Implant Placement in Augmentation Mammaplasty: Dual Plane Subfascial.

Introduction:Breast augmentation is one of the most frequently performed aesthetic surgical procedures in the world. The most important preoperative decisions which influence the final appearance of the augmented breast are the breast implant pocket choice and selection of the most appropriate implant. Described pocket locations are subglandular, subfascial, partially retropectoral, totally submuscular and dual plane.Aim:We have introduced a new method of pocket forming for implant placement, which is combination of Tebbett’s dual-plane 2 or 3 and Graf’s subfascial. We named it as dual plane subfascial.Methods:Between January 2016 and April 2018, total of 27 patients were operated using dual plane subfascial breast augmentation. The pinch test in the medial pole less than 2,0 cm and in upper pole less than 2,5 cm are indications for this technique. In our modification, in primary cases a dissected flap in front of muscle is fasciocutaneous (not cutaneous as in Tebbett’s technique). It will be finally located caudally of pectoral muscle and in front of the lower pole of implant. Fasciocutaneous flap in primary cases and two independent levels of soft tissue coverage (fascial and cutaneous) in secondary cases (subglandular to dual plane subfascial conversion) in front of the lower pole of implants provide better coverage than cutaneous flap alone.Results:Hematoma and infection did not occur in any patient in our study. A capsular contracture grade I/II without the need for reoperation occurred in two patients. In one patient with secondary augmentation minimal bottoming out was noticed (before reoperation patient had significant bottoming out deformity). Minimal palpability of implants is recorded in three patients.Conclusion:Dual plane subfascial is a good option in primary breast augmentation with a well set indication especially in the breasts with the upper pinch test less than 25 mm and medial pinch test less than 20 mm. The idea can be followed even in secondary breast augmentation (subglandular to dual plane subfascial conversion). There is additional soft tissue in front of the implant which led to a less implant palpability, especially in thin patient with smaller amount of subcutaneous fat.

Preoperative Implant Size Is Strongly Associated With Alternations of Implant Size During Secondary Breast Augmentation.

Breast augmentation is one of the most popular cosmetic surgeries performed worldwide. In turn, there has been an increasing number of secondary breast augmentation procedures in recent years. Implant selection at secondary breast augmentation can be a challenge and is affected by a number of factors. The aim of this study was to assess the main factors affecting the decision-making process with regard to implant volume determination prior to implant exchange. Women who underwent elective breast implant exchange between 2012 and 2016 were included in this study. Medical records were used to acquire implant and patient data. The patient's desires, as well as medical considerations, were taken into account during the implant selection process. Two hundred forty-five women with an average age of 43 years (range, 21-69 years) were included in the study. The mean time between primary augmentation and implant exchange was 10 ± 5.7 years. Overall, 192 implants (38.9%) were exchanged with larger implants, 84 implants (17%) were exchanged with smaller implants, and 218 implants (44.1%) were exchanged with implants similar to the preoperative size (±25 mL). In patients who received smaller implants, the mean reduction in implant volume was found to be 78.88 mL. Women were more likely to receive a smaller implant during implant exchange if the preoperative implant volume was larger than 367 mL (P = 0.00006). Among patients who received larger implants, no correlation was found between preoperative and postoperative implant size. A positive correlation was found between the implant age and a reduction in implant size (P = 0.036). However, no correlation was found between the patient's age and the decision to reduce or enlarge implant size upon revision. Almost half of patients receive similarly sized implants during elective implant exchange. Among those who did decide to change their implant size, more than twice as many patients opted for a larger implant as opposed to a smaller one. Relatively large preoperative implant size and longer time since primary augmentation were associated with the selection of smaller implants during exchange. Further studies should be conducted to reinforce these results.

Secondary Breast Augmentation: Is There a Trend for Bigger Implants?

Despite novel assessment tools and 3D simulation, patient's desire for implant size change is one of the most common reasons for revision surgery after primary breast augmentation. In this study, we analysed outcomes and predictive indicators for revision surgeries in a cohort of patients operated on by a single surgeon. All consecutive patients who underwent revision augmentation surgery between 2013 and 2017 by the first author were included in this study. Besides review of medical records, subgroups based on the indication for revision surgery were compared and statistically analysed. A total of 110 patients were included in this study. Revision surgery was performed 97.2months on average after primary augmentation. Eighty-six per cent of patients received larger implants. Indications for revision surgery and associated subgroups were: (1) wish for bigger implants (38%), (2) complication + wish for bigger implants (26%), (3) complication (29%), (4) complication + wish for smaller implants (3%) and (5) wish for smaller implants (3%). Subgroup analysis showed that patients who underwent revision surgery for bigger implants were significantly younger compared to patients who suffered a complication or desired smaller implants. Time to secondary augmentation was significantly shorter in case of wish for size change compared to complications as reason for revision surgery. Implant sizes differed significantly in patients where volume change was the sole indication for surgery compared to revisions performed due to complications. In our cohort of patients, almost all patients who underwent revision surgery after primary breast augmentation received bigger implants. Patients who specifically wished for size change were younger, asked for surgery earlier and received larger volumes compared to patients who underwent revision surgery for other reasons. 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 .

Accidental injection of autologous fat into the breast implant: a case report highlighting radiological findings

Autologous fat grafting is a popular technique for breast augmentation and improving breast contour depressions. It is a technique that involves using the patient’s own adipose tissue to be applied on a subcutaneous area to increase total fat volume. Intraimplant fat is an unexpected finding after autologous fat grafting. A 51-year-old asymptomatic female who underwent breast augmentation with silicone implants and secondary breast augmentation with autologous fat grafting presented with unidentified cluster of radiolucencies superimposed to left implant on screening mammogram. Corresponding MRI revealed intraimplant fat intensities. This case represents a previously unreported intraimplant injection of fat with resultant intracapsular rupture and highlights the radiological findings of intracapsular implant rupture.