Submuscular Implants Research Articles

Evaluation of Pectoral Nerve Blocks Type II (PEC II) for Augmentation Mammoplasty: Prospective, Randomized, and Double-Blind Study

Objective: to study the effectiveness of type II pectoral nerve block (PEC II) for breast augmentation with submuscular implants by assessing opioid consumption and pain scale in the immediate postoperative period, from the post-anesthesia care unit (PACU) to 24 h postoperatively. Methods: A prospective, controlled, randomized, and double-blind study. Thirty-four patients were analyzed during the perioperative period and in the PACU, with one group receiving bilateral PEC II combined with general anesthesia and the control group receiving only general anesthesia. Results: There was no difference between the groups regarding demographic data, surgical and anesthetic times, or intraoperative opioid use. Opioid consumption in the control group was consistently higher at all the time intervals studied, with an average morphine consumption 38.7% greater. The largest variation in morphine consumption occurred at the fourth and sixth hours postoperatively. The greatest difference in postoperative pain was 36% higher in the control group compared to the intervention group. Conclusions: patients who underwent general anesthesia combined with PEC II had lower opioid consumption and a lower postoperative pain score without associated complications, confirming the effectiveness of the procedure.

Enhancing Buttock Contours: A Safer Approach to Gluteal Augmentation with Ultrasonic Liposuction, Submuscular Implants, and Ultrasound-Guided Fat Grafting.

Background: The global popularity of gluteal augmentation has risen significantly, driven by the desire for enhanced buttocks size and shape to align with individual patient preferences. This increased demand has prompted extensive research into diverse techniques and their safety. Methods: A retrospective analysis was conducted to evaluate the outcomes of a gluteal augmentation technique involving ultrasound-assisted liposuction, submuscular implants, and ultrasound-guided fat grafting. Our study involved a review of the medical records of 50 consecutive patients who underwent this procedure between February 2020 and July 2023. Results: Data related to patient demographics, the quantity of fat grafts, and any complications were analyzed. Additionally, a brief survey was conducted to evaluate patient satisfaction. The Polytech implants were used in forty-four patients, and Sebbin implants in six. The implant size varied from 285 to 560. Most of the Polytech implants were 390 cc (25/44; 56.8%). Two patients had a minor infection at the incision sites and subsequent wound dehiscence. No revision surgeries were needed. Conclusions: The presented technique incorporates ultrasonic liposuction, submuscular silicone implants, and ultrasound-guided fat grafting to achieve safe and aesthetic gluteal enhancements. This method is especially suitable for patients looking to augment both the central and lateral areas of the buttocks, particularly when they lack adequate fat tissue for augmentation through fat grafting. With the addition of ultrasound guidance, the fat grafting step is significantly safer.

Oncoplastic Reconstruction in the Setting of Prior Cosmetic Augmentation.

This study explores the surgical management and reconstruction options for augmented breasts in the context of breast conservation therapy (BCT) for breast cancer. We hypothesized that there would be no difference in the rates of complications, revisions, or patient satisfaction in patients who maintained their breast augmentation versus those that had their implants removed in the context of BCT. We conducted a retrospective review of 142 patients who underwent BCT at a single center from March 2016 to March 2022. The study included patients who had a preexistent cosmetic augmentation at the time of breast cancer diagnosis and BCT. Patient demographics, clinical and treatment characteristics, breast implant details, reconstructive technique, complications, and revisions were recorded. Patient-reported outcomes were assessed using the BREAST-Q Breast-Conserving Therapy module. Ninety-three (65.5%) patients chose to maintain their implants, while 49 (34.5%) elected to have them removed during BCT. Patients with submuscular implants were more likely to maintain their implants. Oncoplastic mastopexy was associated with higher complication rates, particularly in patients opting for implant downsizing. However, multivariate logistic regression did not identify implant management strategy as an independent predictor for complications or revisions. Surgical site infection was the only predictor of implant explantation. Patient-reported outcomes did not differ significantly between the different implant management cohorts. This study demonstrates that maintaining breast implants during BCT does not increase the risk of complications or revisions. Overall, BCT in augmented women was found to be a safe approach, with high patient satisfaction.

Implant-Based Breast Reconstruction After Nipple-Sparing and Skin-Sparing Mastectomy in Breast-Augmented Patients: Prepectoral or Submuscular Direct-to-Implant Reconstruction?

Patients with breast augmentation facing a breast cancer diagnosis pose unique challenges for both breast and plastic surgeons in terms of treatment and reconstruction. Traditional submuscular direct-to-implant (DTI) breast reconstruction is often considered the standard approach, regardless of the previous implant pocket. However, recent trends in prepectoral reconstruction provide an innovative solution for patients with previous subglandular and submuscular implants. In this study we aimed to share our experiences with DTI breast reconstruction in patients with a history of breast augmentation, with a specific focus on the viability of prepectoral reconstruction. A retrospective review was conducted on 38 patients with previous breast augmentation who underwent either skin-sparing mastectomy or nipple-sparing mastectomy for breast cancer followed by DTI reconstruction between January 2015 and July 2023. Our analysis considered various factors, including previous implant positioning, capsular and implant status, and mastectomy flap thickness (MFT), offering insights into the rationale behind choosing the new implant positioning. Patients with a history of subglandular breast augmentation and an MFT greater than 1 cm were candidates for prepectoral reconstruction. When the MFT was less than 1 cm but flap vascularity was sufficient, a prepectoral reconstruction was performed; otherwise, retropectoral reconstruction was preferred. Patients with submuscular breast augmentation were evaluated similarly, with submuscular reconstruction chosen when the MFT was less than 1 cm and prepectoral reconstruction preferred when the MFT exceeded 1 cm. Immediate prepectoral DTI reconstruction represents a feasible option for specific patients with a history of breast augmentation. Decisions regarding the reconstructive approach are influenced by variables such as mastectomy flap thickness, implant status, and capsular conditions.

Prepectoral versus Submuscular Implant-Based Breast Reconstruction: A Matched-Pair Comparison of Outcomes.

Implant-based breast reconstruction is the most common reconstructive approach after mastectomy. Prepectoral implants offer advantages over submuscular implants, such as less animation deformity, pain, weakness, and postradiation capsular contracture. However, clinical outcomes after prepectoral reconstruction are debated. The authors performed a matched-cohort analysis of outcomes after prepectoral and submuscular reconstruction at a large academic medical center. Patients treated with implant-based breast reconstruction after mastectomy from January of 2018 through October of 2021 were retrospectively reviewed. Patients were propensity score exact matched to control demographic, preoperative, intraoperative, and postoperative differences. Outcomes assessed included surgical-site occurrences, capsular contracture, and explantation of either expander or implant. Subanalysis was done on infections and secondary reconstructions. A total of 634 breasts were included (prepectoral, 197; submuscular, 437). A total of 292 breasts were matched (146 prepectoral:146 submuscular) and analyzed for clinical outcomes. Prepectoral reconstructions were associated with greater rates of SSI (prepectoral, 15.8%; submuscular, 3.4%; P < 0.001), seroma (prepectoral, 26.0%; submuscular, 10.3%; P < 0.001), and explantation (prepectoral, 23.3%; submuscular, 4.8%; P < 0.001). Subanalysis of infections revealed that prepectoral implants have shorter time to infection, deeper infections, and more Gram-negative infections, and are more often treated surgically (all P < 0.05). There have been no failures of secondary reconstructions after explantation in the entire population at a mean follow-up of 20.1 months. Prepectoral implant-based breast reconstruction is associated with higher rates of infection, seroma, and explantation compared with submuscular reconstructions. Infections of prepectoral implants may need different antibiotic management to avoid explantation. Secondary reconstruction after explantation can result in long-term success. Therapeutic, III.

Primary Breast Augmentation Using Axillary Skin Incision, Submuscular Implants, and Intraoperative Tissue Expansion

Background:Primary breast augmentation in small, pointed, or tubular breasts using axillary skin incision, submuscular cohesive gel implants, and intraoperative tissue expansion dramatically reduces complications.Methods:A 2.5- to 3.5-cm-long incision is made in the hair-bearing part of the axillae beside a natural fold. Incisions are opened using dissection away from the axillae, and an opening is made underneath the muscle on top of the thoracic cage. Blunt finger dissection is performed, and temporary breast expanders and special dissectors are inserted. The expanders create volume and desired breast shape. Sterility is ensured by entering implant pockets only with expanders and elevators and changing gloves before placing implants. No irrigation or antibiotic solution is used on implants or in the pockets. One thousand three hundred ten breast augmentations were performed between 2004 and 2019 (including a 2-year follow-up) using textured, cohesive round implants. Patients were followed up 3–4 months postoperatively. The parameters analyzed were size, shape, firmness, scars, and sensation in the nipple areola complexes. Patients contacted the clinic if problems occurred.Results:Of the 1,310 patients, only 2 had a Baker grade 3–4 capsular contraction. We also found 2 cases of implant rupture at the end of the 10-year guarantee period. Implants were replaced with identical ones. No infections were seen. Six cases of implant malposition were corrected by surgery. The total number of reoperations was 10 (0.8%).Conclusions:The axillary skin incision is an extremely efficient technique with few complications. The lymphatic drainage system is preserved, and implant pockets are left in a virgin state.

Immediate One-Stage Implant-Based Breast Reconstruction after Conservative Mastectomy: Sub-Pectoral or Pre-Pectoral? A Proposal for a Randomized Multicentric Trial to Define Indications and Outcomes.

Background: Implant-based breast reconstruction (IBR) is the most common reconstructive procedure after mastectomy. During the last 10-15 years, the introduction of Acellular Dermal Matrices (ADMs)/synthetic meshes has driven a change in practice from complete submuscular implants to sub-pectoral implants. In the last 5-7 years pre-pectoral IBR with complete ADM/mesh cover gained popularity as an alternative to sub-pectoral IBR and is considered the procedure of choice in athletic, active women. Avoiding disturbance of muscular structures has the theoretical advantages of reduced post-operative pain and operative time and prevention of animation deformity. However, long-term outcomes are still not available and possible disadvantages of pre-pectoral IBR might be increased palpability of implant edges and upper pole wrinkling, possibly leading to more revisional surgery.

The role of fat grafting in prepectoral breast reconstruction

Prepectoral breast reconstruction has reemerged as a promising alternative to submuscular implants, as they place the patient at lower risk for pain, muscular impairment, and animation deformity. However, the thinner amount of overlying tissue in prepectoral reconstruction presents its own unique set of challenges. A "rippling" deformity is seen in some prepectoral patients, which is typically corrected with fat grafting. This report details our recommended technique for fat grafting in the prepectorally implanted patient.

Factors Associated With Complications in Immediate Breast Reconstruction in 1 Stage With Completely Submuscular Implants.

Immediate breast reconstruction in 1 stage using permanent implants is gaining popularity and can be performed with or without the use of acellular dermal matrices. This study aimed to investigate the results of breast implants placed submuscularly without acellular dermal matrix and assess the factors affecting surgical complications. From November 2009 to March 2018, 138 patients underwent immediate breast reconstruction with permanent submuscular implants after concomitant skin-sparing or nipple-sparing mastectomies in a single institution. All implants were covered with sufficient soft tissue under a submuscular pocket. One hundred thirty-eight patients were enrolled, and a total of 196 breasts were operated. The average age and body mass index (BMI) of the patients were 44.9 ± 8.8 years and 23.7 ± 3.6 kg/m, respectively. The majority of the mastectomies were therapeutic (81%). The average volume of implants was 389 ± 89 mL, and the mean follow-up was 33 months. The overall complication rate was 17% (n = 23), with skin necrosis being the most common complication followed by infections. Having a BMI equal to or greater than 25 kg/m was found to be a statistically significant predictor for overall complications (P = 0.002), whereas smoking history, age, and implant volume were not statistically significant. Immediate breast reconstruction in 1 stage using permanent implants can be performed with acceptable complication rates and cosmetic outcomes. Our study demonstrated that high BMI is a risk factor for overall complications. With proper patient selection and surgical technique, implants could be completely covered under a submuscular pocket.

Extended Experience with High Submuscular Placement of Urological Prosthetic Balloons and Reservoirs: Refined Technique for Optimal Outcomes

IntroductionSince 2012, we have routinely placed urological prosthetic balloons and reservoirs in a high submuscular location between the transversalis fascia and rectus abdominis muscle during inflatable penile prosthesis and artificial urinary sphincter surgery. We review our experience of more than 600 high submuscular cases, describe refinements in our technique through time and compare outcomes to prior consecutive space of Retzius prosthetic cases. MethodsWe retrospectively reviewed patients who underwent inflatable penile prosthesis and/or artificial urinary sphincter placement between January 2009 and April 2016. Complications and need for surgical revision were recorded and compared between the 2 placement locations. ResultsDuring the study period 872 prosthetic cases were performed, including 619 high submuscular cases from 2012 to 2016 (inflatable penile prosthesis in 344, artificial urinary sphincter in 275). Of 399 first-time high submuscular implants 54 (14%) required revision, of which 8 (2%) were attributable to the urological balloon or reservoir due to “pain/bother” (4) or herniation (4). Of the 161 space of Retzius urological balloons and reservoirs placed from 2009 to 2011 a similar rate of herniation (3 cases, 1.9%) was noted, although higher rates of deep pelvic complications (3, 1.9%) were noted compared to high submuscular cases (2, 0.5%; p=0.14). Since implementing our refined high submuscular technique, no deep pelvic complications have occurred. ConclusionsExperience with high submuscular placement of urological balloons and reservoirs confirms that it is safe and well tolerated. With refinements in technique the complication rates are similar in frequency to those with space of Retzius but appear to be minor in nature with negligible risk of visceral or vascular injury.

Symmetrization using submuscular implants to achieve lasting results in breast reconstruction

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

The Impact of Breast Implant Location on the Risk of Capsular Contraction.

Although many theories exist, the etiology of capsular contraction (CC) development is still not known. Anatomic location has been suggested as a possible risk factor, but rates of CC development vary between studies, often with conflicting results. This study examines the risk developing CC with subglandular compared to submuscular placement of the breast implant. A total of 1,283 studies were identified from December 2003 to December 2013 by PUBMED and MEDLINE searches and a manual search strategy. Two levels of screening resulted in 10 studies suitable for meta-analysis, providing data on a total of 17,520 breast implants. All statistical calculations were performed with Review Manager (RevMan) version 5.2.7. Random-effect (RE) pooled relative risk (RR) and confidence intervals (CI) were calculated for capsular contraction. The risk of developing capsular contraction with subglandular implants was more than 2-fold increased compared to submuscular implants (RE RR 2.18; 95% CI 1.41-3.35; P = 0.0005). The trend was not examined with regards to subfascial placement compared to submuscular or subglandular because more studies are needed to determine this. This analysis demonstrated a more than 2-fold increase in the risk of capsular contraction with subglandular compared to submuscular breast implant location. Risk.

Reduction mastoplasty with submuscular implants for breast symmetrization in patients undergoing mastectomy

Reduction mastoplasty with submuscular implants for breast symmetrization in patients undergoing mastectomy

Successful Deep Inferior Epigastric Perforator Flap Breast Reconstruction Following Prior Deep Inferior Epigastric Source Vessel Ligation

INTRODUCTION: Deep inferior epigastric perforator (DIEP) flaps represent an excellent method of breast reconstruction. Its success is predicated upon careful dissection of the dominant deep inferior epigastric (DIE) perforators and the patency of its associated source vessels. Prior ligation of the DIE vessels would thereby negatively impact DIEP flap harvest. If collateral branches maintain the patency of these source vessels, DIEP flap harvest may still be possible. We have successfully performed two bilateral DIEP breast reconstructions following prior ligation of the DIE source vessels. METHODS: A retrospective review of two cases of DIEP breast reconstruction was performed following prior ligation of the DIE source vessels. The characteristics and findings in these specific cases were analyzed. RESULTS: The first patient had multiple failed attempts at bilateral breast reconstruction using implants and latissimus flaps. The right chest wall had been previously radiated. A bilateral salpingo-oophorectomy had been performed for ovarian carcinoma via a Pfannenstiel incision. The DIE source vessels were found to be ligated and transected bilaterally from her gynecologic procedure near their origin at the iliac vessels. Although diminutive in size, intercostal collaterals near the hemoclips maintained source vessel patency and bilateral DIEP reconstruction was completed. The second patient had prior latissimus-based breast reconstructions with submuscular implants. This was complicated by a right-sided infected seroma and bilateral implant capsular contracture. She had undergone a prior delay procedure for possible pedicled TRAM flap reconstruction but did not wish to sacrifice her rectus muscles. CT angiography was performed of the abdomen and pelvis for possible gluteal artery perforator flap reconstruction. Despite clips on the DIE vessels near their origin, they appeared patent and of suitable caliber with sufficient length for bilateral breast reconstruction. Bilateral DIEP breast reconstruction was successfully performed without any associated complications. CONCLUSION: Successful DIEP flap reconstruction depends upon the patency of the DIE source vessels and sufficient perforators to maintain normal flap perfusion. Prior ligation of the DIE source vessels would therefore negatively impact successful flap harvest. If, however, collateral vessels maintain the patency of these source vessels, DIEP flap reconstruction can thereby be carried out successfully as demonstrated by these two cases. Radiologic imaging can aid in identifying such cases.

Biplanar Oncoplastic Surgery

Biplanar oncoplastic surgery represents a novel technique with which to address partial breast reconstruction defects in small to medium sized breasts. Traditional oncoplastic volume displacement techniques may correct contour irregularities but do not address volumetric asymmetries. Volume replacement techniques classically rely on autologous tissue flaps. A biplanar approach, with a combination of glandular rearrangement techniques and volume enhancement with submuscular implants, can result in an alternative approach in select patients to achieve symmetry. Therapeutic, V.

Double Capsule, Unpredictability and High Revision Rates

INTRODUCTION: Breast Augmentation with implants is probably the most frequently performed cosmetic surgery in the world. The manufacturing industry continues to evolve, constantly introducing different implants shapes and textures to minimize common problems like capsular contraction. Unfortunately, there seems to be a correlation of a new generation of aggressively textured breast implants and a phenomenon called double capsule1. We present a retrospective study of 735 patients which 53 had double capsule after breast augmentation with Biocell textured implants. METHODS: All patients had submuscular implants (fit to pocket) using Allergan Natrelle round implants. 62 patients presented unsatisfactory results after surgery. We divided the patients in three groups: Group 1 - asymmetries (difference in implants position, n=18), Group 2 - deformities (capsular contracture, n=34) and Group 3 – emergency scenarios (seroma, n=10). The group one was composed of patients that had one breast in a different position than the other 3 months following the original surgery. The second group consisted of patients who presented some hardening of the breasts after 3 months. Finally, the third group constituted patients that had a sudden increase of breast size and had emergency surgery. The follow-up period was 3 years. RESULTS: In Group 1, 50% of the patients who had asymmetry in the implants position, had double capsule and the other half had an over adherence of the implant, similar to what we find with polyurethane implants (Figure 1). Nevertheless, this adherence was not present on the other breast, causing distortion of the breast shape. In Group 2, all patients had double capsule. In Group 3, all patients had seroma and double or multiple capsules. In our series, patients were required to have revision surgery in 8,43% of cases. Double capsules were responsible for 85,48% of all of our breast augmentation revisions on the last 3 years (Figure 2).Figure 1: Right Breast implant in an asymmetric position. 6m post-operative.Figure 2: Same patient presenting double capsule.CONCLUSION: Limited information provided by the implants’ manufacturers is misleading and highly disconcerting. There seems to be overwhelming concerns regarding patients’ safety, thus the authors suggest that further investigation in this area is paramount.

Book Review: The Art of Gluteal Sculpting

Constantino Mendieta . The Art of Gluteal Sculpting. St Louis, MO: Quality Medical Publishing, 2011. ISBN-10: 1576262650 The Art of Gluteal Sculpting , written by Dr Constantino Mendieta, is divided into 2 parts: Basics and Technique. In the Basics section, the author explains the relation between gluteal anatomy and the visible landmarks in the buttock contour, explaining individual variations. The Technique section is very detailed in its coverage of buttock fat sculpting, fat grafting, and the use of intramuscular and submuscular implants, along with the correction of gluteal ptosis and excess skin in normal-weight patients and in those with massive weight loss. Two DVD videos are also included: one on gluteal reshaping with fat and the other on skin removal from the medial aspect of the gluteal region to improve gluteal shape. The book benefits greatly from the author's extensive experience and his unique perspective. For example, in a section titled “Aesthetic Unit Analysis,” the author divides the buttock area, lumbar area, and the proximal region of the posterior thighs into 11 …

Barreira cutânea para reconstrução mamária com prótese

INTRODUÇÃO: A reconstrução mamária imediata com implante de silicone após mastectomia subcutânea tornou-se uma opção válida para médicos e pacientes devido à simplicidade das manobras cirúrgicas, menor tempo cirúrgico, cicatriz mínima e resultados estéticos imediatos. Os implantes submusculares também são recomendados, apesar de exigirem um procedimento cirúrgico mais agressivo. Ambos também podem causar problemas secundários que já foram descritos. Para reduzir esse tipo de problemas, neste artigo é descrita uma modificação da mastopexia circunvertical, redução do padrão de mamoplastia para mastectomia e a reconstrução mamária imediata com implante. MÉTODO: A pele entre as linhas de incisão cutânea medial e vertical lateral é desepitelizada, criando uma barreira cutânea para a prótese para reforçar a linha de sutura vertical. CONCLUSÕES: A técnica garante uma reconstrução segura, com resultados estéticos gratificantes.

Canadian breast implant cohort: Extended follow‐up of cancer incidence

Cosmetic breast implants are not associated with increased breast cancer incidence, but variations of risk according to implant characteristics are still poorly understood. As well, the assessment of cancer risk for sites other than breast needs to be clarified. The purpose of this study was to fill these research gaps. This study presents an extended analysis of 10 more years of follow-up of a large Canadian cohort of women who received either cosmetic breast implants (n = 24,558) or other cosmetic surgery (15,893). Over 70% of the implant cohort was followed for over 20 years. Cancer incidence among implant women was compared to those of controls using multivariate Poisson models and the general female population using the standardized incidence ratios (SIRs). Women with breast implants had reduced rates of breast and endometrial cancers compared to other surgery women. Subglandular implants were associated to a reduced rate of breast cancer compared to submuscular implants [incidence rate ratio (IRR) = 0.78, 95% confidence interval (CI) = 0.63-0.96] and this reduction persisted over time. We observed a sevenfold increased rate (IRR = 7.36, 95% CI = 1.86-29.12) of breast cancer in the first 5 years after the date of surgery for polyurethane-coated subglandular implant women but this IRR decreased progressively over time (p value for trend = 0.02). We also observed no increased risk of rarer forms of cancer among augmented women. A reduction in breast cancer incidence was observed for women with subglandular implants relative to women with submuscular implants. Possible increase of breast cancer incidence shortly after breast augmentation with polyurethane implants needs to be verified.

The influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants

Capsular contracture occurs more frequently when immediate breast reconstruction (IBR) is associated with radiotherapy (RT) in a post-mastectomy field. The aim of this study was to investigate the impact of RT on surgical outcome after IBR using a single implant type. One hundred and thirty-six breast reconstructions were studied in 114 patients: 62 reconstructions were performed using submuscular implants alone and 74 had an implant-assisted latissimus dorsi myocutaneous flap using a McGhan 150 biodimensional permanent expander implant. Data were prospectively collected on capsule contracture, geometric measurements, photographic assessments and pain scores. The median follow-up was 4 (range, 2-5) years. The mean age of the 114 patients studied was 45 (range, 20-77) years. Forty-four reconstructed breasts received RT. Capsule formation was detected in 13/92 (14.1%) reconstructed breasts with no RT and in 17/44 (38.6%) reconstructed breasts with RT. On univariate analysis, RT was the only variable related to capsule formation (p<0.001). Significant differences in geometric measurements of symmetry were identified in patients with capsules compared with those without capsules. Photographic assessments were worse in the capsule group: mean photo score 8 (95% CI 8, 8.5) compared with the no capsule group 6.5 (95% CI 5, 7.5), p<0.001. Persistent pain two years or more after surgery was present in 8/30 patients with capsules and 1/106 with no capsule group, p<0.01. Capsule formation is three times more likely to occur after IBR in association with an RT field. However, as more than 60% of patients do not get capsules despite RT at four years, implant-assisted tissue expansion techniques using a biodimensional device is a viable breast reconstructive option in selected cases.