Submuscular Position Research Articles

Lidocaine Diffusion in Five Tissue Expanders: An In Vitro and In Vivo Study

Previous work in our laboratory has demonstrated that tissue expanders are permeable to lidocaine. In this two-part study, we assessed the in vitro lidocaine diffusion in the following five common tissue expanders: Dow Corning, McGhan, Cox-Uphoff, Hyer-Schulte (Mentor), and Surgitek. In part 1, we demonstrated that wall thickness appeared to be the major determinant for diffusion. Part 2 reports an in vivo study of lidocaine diffusion from tissue expanders used for breast reconstruction. We initially determined that there is incomplete mixing between the valve and connecting tubing and the contents of the expanders, over the period of 1 week. We subsequently examined the lidocaine diffusion from seven tissue expanders placed in a submuscular position for breast reconstruction. The rate of lidocaine diffusion was highly variable, but on average was about 3% per day.

The management of severe capsular contractures following breast augmentation

Several patients with severe capsular contracture following conventional augmentation mammoplasty with subcutaneously placed implants have had substantial improvement by replacing the implants in a submuscular position.

Adjustment of the contralateral breast following breast reconstruction.

Surgery on the contralateral breast was performed in 64 of 100 patients for adjustment of size and shape or for diagnostic purposes. The patients found it more desirable to adjust size than shape asymmetry on the contralateral breast. There was only one early complication and six late ones. The former was a postoperative hematoma after a reduction mammaplasty. The latter were three cases of capsular contractures after augmentation mammaplasties. In these cases the implant was placed in a submuscular position. In three cases, patients asked for a secondary reduction mammaplasty because of poor symmetry. There were some difficulties in comparing pre- and postoperative mammography after augmentation mammaplasty. In the other adjustment procedures, there were only minor difficulties in a few cases comparing pre- and postoperative mammography. Patients with a high risk of bilateral breast cancer needing size and/or shape symmetry correction should be considered for mastectomy and immediate reconstruction.

SUBMUSCULAR MAMMARY PROSTHESES IN RECONSTRUCTIVE BREAST SURGERY

The anatomical basis and operative technique for insertion of mammary prostheses in the completely submuscular position are described. The results of 38 completely submuscular prostheses used for reconstructive breast surgery form the basis of this report. The two major advantages of the method, freedom from major complications, and a reduced incidence of deforming fibrous capsular contracture, have important implications in reconstructive breast surgery.