Subpectoral Breast Augmentation Research Articles

Inferolateral Pectoralis Sling Technique for Augmentation Mastopexy.

Augmentation mastopexy remains a challenging procedure. The goal is to achieve correction of breast ptosis whilst adding implant volume, and avoid complications of premature waterfall deformity, bottoming out and further revision surgery, particularly when using smooth implants. We aim to describe and evaluate a technique to reduce implant malposition in augmentation mastopexy. This is a technical description and retrospective review of a single surgeons' cases from 2019 to 2022 of all patients who underwent 1 stage subpectoral breast augmentation mastopexy with the inferolateral pectoralis sling. Over the four year period, 284 patients (568 breasts) underwent augmentation mastopexy with the inferior pectoralis sling. Mean implant size was 360.7cc (range 180-625cc). There were no early complications and 6 (2.1%) patients had late minor complications, with five (1.8%) undergoing revision mastopexy with implant repositioning and 1 (0.4%) undergoing areola scar revision. 20 patients (7%) underwent an implant upsize procedure with the average volume increase being 218.5cc and the average time to upsize 13.6 months (range 6-36months) CONCLUSIONS: Use of the inferolateral pectoralis muscle sling allows successful one stage augmentation mastopexy with low complication and revision rates. 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 .

Pain Levels Following Cosmetic Breast Surgery and An Easy-To-Use Pain Treatment Algorithm for Plastic Surgeons.

The purpose of this study was to examine the degrees of pain experienced following various breast cosmetic surgery procedures and to evaluate the existing pain treatment methods. Patients who underwent subpectoral breast augmentation, mastopexy, or breast reduction between 2017 and 2022 were evaluated retrospectively. A total of 90 patients were randomly selected, with 30 patients in each group. The visual analog scale (VAS) was used to assess pain levels. The data were analyzed using the statistical program SPSS 22.0 (IBM Corp., Armonk, NY, USA). The subpectoral breast augmentation group exhibited the highest recovery VAS score. Postoperative 1, 2, 4, 6, 12, and 24-h VAS values were higher in the breast augmentation group than in the breast reduction and mastopexy groups. No statistically significant difference observed between mastopexy and breast reduction in terms of VAS scores during the evaluation periods. Statistically significant higher VAS scores were observed for subpectoral breast augmentation at all times compared to the preoperative period. Subpectoral breast augmentation is associated with higher levels of postoperative pain compared to breast reduction and mastopexy. Effective postoperative pain prevention is crucial following aesthetic breast surgeries. It not only helps to reduce hospital stays but also aids in patient recovery, facilitates a quicker return to daily activities, and enhances patient satisfaction. To achieve this objective, it is advantageous to utilize a practical pain treatment algorithm that is readily applicable. 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 .

Minimal-Invasive Mitral Valve Repair after Breast Augmentation

Minimal-invasive mitral valve surgery after breast augmentation is an ongoing interdisciplinary challenge. Notably, the perioperative explantation of the breast implant, as reported in most cases, is of questionable benefit. We herein report on successful minimal-invasive mitral valve repair after subpectoral breast augmentation with perioperative preservation of the breast implant in situ.

Intrathoracic migration of a breast implant seven years after thoracotomy. A case report.

A 52-year-old woman, who had previous bilateral subpectoral breast augmentation, underwent thoracotomy for a right upper lobe pulmonary adenocarcinoma. Seven years after her thoracic surgery, the patient noticed a reduction in her right breast volume, with shortness of breath and cough. A computed tomography study of the chest revealed intrathoracic migration of her right breast implant with no sing of capsule rupture. Subsequent video-assisted thoracoscopy confirmed this diagnosis.

Nonsubjective Assessment of Shape, Volume and Symmetry during Breast Augmentation with Handheld 3D Device.

Three-dimensional Surface Imaging (3DSI) has become a valuable tool for planning and documenting surgical procedures. Although surface scanners have allowed for a better understanding of breast shape, size, and asymmetry during patient consultation, its use has not been included in intraoperative assessment so far. Validation of the reliability of the intraoperative use of a portable handheld 3DSI equipment as a tool to evaluate morphological changes during breast augmentation surgery. The patients who underwent bilateral subpectoral breast augmentation through an inframammary incision were included in this study. Intraoperative 3DSI was performed with the Artec Eva device, allowing for visualization of the surgical area before incision, after use of breast sizers and implant, and after wound closure. Intraoperatively manual measurements of breast distances and volume changes due to known sizer and implant volumes were in comparison with digital measurements calculated from 3DSI of the surgical area. Bilateral breasts of 40 patients were 3D photographed before incision and after suture successfully. A further 108 implant sizer uses were digitally documented. There was no significant difference between manual tape measurement and digital breast distance measurement. Pre- to postoperative 3D volume change showed no significant difference to the known sizer and implant volume.

Patient-Reported Outcomes after Subpectoral Breast Augmentation with Microtextured or Macrotextured Implants Using the BREAST-Q.

Background Breast augmentation with implants is the most commonly performed cosmetic plastic surgery in Brazil and worldwide. The aim of this study was to assess patient satisfaction and quality of life following subpectoral breast augmentation with either microtextured or macrotextured implants, using the BREAST-Q. Methods A prospective study was conducted with 40 women with hypomastia undergoing subpectoral breast augmentation. The patients were randomly allocated to two groups to receive either microtextured or macrotextured breast implants. All participants were assessed preoperatively (baseline) and after 2 and 4 months of surgery for quality of life and patient satisfaction with the surgical results, using the BREAST-Q augmentation module, a patient-reported outcome measure. Results The patients had a mean age of 28.9 ± 6.45 years. The microtextured ( n = 20) and macrotextured ( n = 20) groups were homogeneous for sex, age, education level, marital status, and number of children ( p > 0.05). Both groups showed significant improvement in satisfaction with breasts ( p < 0.001), psychosocial well-being ( p < 0.001), and sexual well-being ( p < 0.001) at the 2- and 4-month follow-up visits compared with baseline. The observed improvements were associated with high effect size values of 5.09, 3.44, and 3.90, respectively. In contrast, significant decreases from baseline in physical well-being scores ( p = 0.001) were found 2 and 4 weeks after surgery in both groups. Conclusion Subpectoral breast augmentation with either microtextured or macrotextured breast implants improved satisfaction with breasts and quality of life in patients with hypomastia.

Extramuscular and Intramuscular Course of the Nerve Innervating the Abdominal Part of the Pectoralis Major Muscle: An Anatomical Study with Regard to Transaxillary Endoscopic Subpectoral Breast Augmentation.

During transaxillary endoscopic subpectoral breast augmentation, the innervation of the abdominal part of the pectoralis major muscle can be injured. The question has been raised whether this could even be of value, as for a better result, the caudal fibers of the pectoralis major muscle have to be detached from their origin. The authors' aim was to identify the exact position and the intramuscular course and target of these nerve branches. Fifty pectoralis major muscles and their supplying nerve branches from 27 formalin-fixed anatomical specimens were studied using macroscopic dissection and anthropometry. Furthermore, eight muscles underwent the modified Sihler procedure to determine the intramuscular course and target of the supplying nerve branches. The branches for the abdominal part of the pectoralis major muscle pierced the pectoralis minor muscle or coursed around its lower border 3.2 to 8.4 cm from the tip of the coracoid process. Within the muscle, at least one small nerve branch, innervating the abdominal part, ascended into the lowermost portion of the sternocostal head, and anastomosed with the lowest small branch of its supplying nerve branches. Because of the variable position of the nerve branches, they may often cross the operative field during transaxillary endoscopic breast augmentation. However, their interruption can be of value, because weakening of the lower part of the pectoralis major muscle is desired to keep the implant in place, and to avoid animation deformity.

PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study

Background and objectivesPECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population. MethodsThis was a randomized, double-blind, placebo-controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg-1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0 − 10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha < 0.05). ResultsIn the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23 − 5.56; mean 95% CI), 3.75 (3.13 − 4.37), 3.79 (2.93 − 4.64), and 2.29 (1.56 − 3.01), respectively, whereas in the placebo group, they were 4.96 (4.32 − 5.60), 4.00 (3.50 − 4.49), 3.93 (3.12 − 4.73), and 2.29 (1.56 − 3.01), respectively. ConclusionsPECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.

Bloqueio PECS I para analgesia pós‐operatória em pacientes submetidos a mamoplastia de aumento: estudo randomizado, duplo‐cego, controlado por placebo

Background and objectivesPECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population. MethodsThis was a randomized, double‐blind, placebo‐controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg‐1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0−10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha<0.05). ResultsIn the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23−5.56; mean 95% CI), 3.75 (3.13−4.37), 3.79 (2.93−4.64), and 2.29 (1.56−3.01), respectively, whereas in the placebo group, they were 4.96 (4.32−5.60), 4.00 (3.50−4.49), 3.93 (3.12−4.73), and 2.29 (1.56−3.01), respectively. ConclusionsPECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.

Prospective Study of Saline versus Silicone Gel Implants for Subpectoral Breast Augmentation.

Silicone gel implants are regarded as esthetically superior to saline implants, offering a more natural consistency. They are also considered less susceptible to rippling. However, objective measurements and patient-reported outcome studies are lacking. Similarly, minimal data are available quantitating animation deformity. A 3-year prospective study was undertaken among 223 women undergoing primary subpectoral breast augmentation using either saline (n = 145) or silicone gel (n = 78) implants. Photographs obtained included frontal views with the patient flexing the pectoral muscles. Images were matched, and vertical differences in nipple position were measured. Breast implants were evaluated using high-resolution ultrasound to detect any ripples or folds at least 3 months after surgery. Outcome surveys were administered. Statistical analysis included the χ2 test, point-biserial correlations, and a power analysis. Respondents reported visible rippling in 18% of women and palpable rippling in 32% of patients, with no significant difference between women treated with saline and silicone gel implants. Ripples were detected on ultrasound scans in 24% of women with saline implants and in 27% of women with silicone gel implants (difference not significant). Ripples were more common in women with lower body mass indices. Fifty percent of patients demonstrated nipple displacement <1 cm on animation. Nipple displacement occurred either up or down with equal frequency and a mean overall nipple displacement of zero. Saline and silicone breast implants produce similar degrees of rippling, as determined on outcome surveys and ultrasound examination. Animation deformities tend to be minor and well-tolerated.

Our Experience With Transumbilical Breast Augmentation: Largest Published Series to Date With 2263 Patients

Transumbilical Breast Augmentation (TUBA) represents a unique approach for breast augmentation (BA). The endoscopic-guided procedure allows for placement of saline breast implants above or below the pectoralis major muscle without placing any incisions on or near the breast. The procedure has not been widely adopted likely due to the high learning curve and the need for advanced endoscopic skills. In addition, silicone implants have increasingly become more popular than saline implants for multiple reasons over the years, which has naturally decreased the number of TUBA cases. Here, we present the largest series of TUBA cases performed at a single institution and present our standardized reproducible technique to promote wider application of TUBA in Cosmetic Surgery. This is a single-institution retrospective study that included 2263 patients (4526 implants) between 1994 and 2017. All cases were performed under tumescence anesthesia with monitored intravenous sedation. Operating time, conversion to another approach, early and late complications, and patient satisfaction were studied. Our data were compared with the available studies via an extensive literature review. In total, 2263 patients (4526 implants) were included in the study. There was 1 case that required unilateral intraoperative conversion to periareolar approach in the initial experience for technical difficulty. Five small postoperative hematomas occurred that were successfully treated with conservative management and did not require evacuation, and 4 out of 5 postoperative hematomas occurred in subpectoral BA and 1 occurred in subglandular BA. Average operating time was 45 minutes. Remote Grade III and IV capsular contracture occurred in 113 patients requiring capsulectomy through periareolar approach. There were 3 cases of superficial umbilical wound infection that occurred, 1 in subglandular BA and 2 in subpectoral BA. These cases were treated with oral antibiotics and local wound care. No implant infection occurred. There were 32 cases of mild asymmetry that were acceptable by patients and did not require a revision, 19 cases occurred in the subpectoral BA group, and 13 cases occurred in the subglandular BA group. The procedure yielded a very high satisfaction rate. TUBA is a safe and reproducible procedure for BA with short operative time, high patient satisfaction, and comparable outcomes with other approaches.

Iatrogenic Symmastia: Causes and Suggested Repair Technique.

Various theories exist to explain the etiology of iatrogenic symmastia. Subglandular over-dissection of the medial breast pocket over the sternum, disruption of midline sternal fascia, oversized implant base diameter, and over-dissection of the medial pectoralis muscle attachments to the sternum are popular explanations. The authors hypothesized that the most common risk factor for iatrogenic symmastia is subpectoral breast augmentation. A retrospective chart review was conducted including all symmastia patients who underwent surgery from January 2008 to April 2018 by a single surgeon (C.L.M.). ASAPS members were also surveyed regarding the etiology and incidence of symmastia in their practice. Twenty-three patients with symmastia were included in the retrospective chart review. All had previous subpectoral breast augmentation. In the ASAPS survey, 91 plastic surgeons reported seeing an average of 2.2 consults for acquired symmastia over the preceding year; 1.9 of the 2.2 (84.9%) acquired symmastia consults previously underwent subpectoral breast augmentation. Most surgeons attributed these patients' symmastia to over-dissection of the medial pectoralis muscle attachments to the sternum. Symmastia is most often caused by pectoralis major sternal dehiscence during subpectoral breast augmentation. In the senior author's experience, all patients with iatrogenic symmastia previously had a submuscular breast augmentation. The ASAPS survey supports multiple causes for symmastia with retromuscular breast augmentation occurring in the majority of patients. Repair of symmastia should include securing Scarpa's fascia to the sternum, reattaching the pectoralis major to the sternum, avoiding another subpectoral implant, and using postoperative modalities to protect the repair.

Comparison of incisions between two approaches in transaxillary breast augmentation

Objective To compare the coronary incision with the sagittal incision in transaxillary breast augmentation. Methods A total of 60 patients who underwent transaxillary subpectoral breast augmentation with round breast implants were randomly allocated into two groups: Group A (30 patients) received coronary incision, while Group B received sagittal incision. The operative time of implant insertion, the distinction of scar and the repair rate of scar were compared between the two groups. Results The mean operative time of implant insertion in group A was (14.55±3.79)s, and that in group B was (27.38±6.79) s, with statistically significant difference (t=9.03, P 0.05) or the repair rate of scar (χ2=0.35, P>0.05) between two groups. Conclusions As for the operative time of implant insertion, the coronary incision is better than the sagittal incision. Key words: Axillary approach; Coronal incision; Sagittal incision; Breast augmentation; Prosthesis implantation; Operation time

The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: A prospective, randomised study

PurposeThe present study was planned to evaluate the efficacy and safety of ultrasound-guided Pecs I and II blocks for postoperative analgesia after sub-pectoral breast augmentation. MethodsFifty-four adult female patients undergoing breast augmentation were randomly divided into two groups: the control group (Group C, n=27) who were not subjected to block treatment and Pecs group (Group P, n=27) who received Pecs I (bupivacain 0.25%, 10mL) and Pecs II (bupivacain 0.25%, 20mL) block. Patient-controlled fentanyl analgesia was used for postoperative pain relief in both groups, and the patients were observed for the presence of any block-related complications. ResultsThe 24-h fentanyl consumption was smaller in Group P [mean±SD, 378.7±54.0μg and 115.7±98.1μg, respectively; P<0.001]. VAS scores in Group P were significantly lower at the time of admission to the post-anaesthetic care unit and at 1, 2, 4, 8, 12, and 24h (P<0.001). The rates of nausea and vomiting were higher in Group C than in Group P (9 vs 2, P=0.018). Hospital stay duration was shorter in Group P than in Group C (24.4±1.2h vs 27.0±3.1h, P<0.001). No block-related complications were recorded. ConclusionsCombine used of Pecs I and II blocks provide superior postoperative analgesia in patients undergoing breast augmentation and shortens hospital stay.

The Montreal Augmentation Mammaplasty Operation (MAMO) Simulator: An Alternative Method to Train and Assess Competence in Breast Augmentation Procedures.

Surgical residents' exposure to aesthetic procedures remains limited in residency training. The development of the Montreal augmentation mammaplasty operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. To perform face, content, and construct validations of the MAMO simulator for subpectoral breast augmentation procedures and assess the reliability of the assessment scales used. Plastic surgery staff and residents were recruited to perform a subpectoral breast augmentation on the simulator. Video recordings of their performance were blindly evaluated using the objective structured assessment of technical skills (OSATS) system consisting of the global rating scale (GRS), mammaplasty objective assessment tool (MOAT), and a surgery-specific Checklist score. Fourteen plastic surgery residents and seven expert plastic surgeons were enrolled. Experts' performance was significantly higher than residents' according to each of GRS, MOAT, and Checklist scores. Mean values of residents and experts were 23.4 (2.5) vs 36.9 (3.1) (P < 0.0001) for GRS score, 30.4 (2.2) vs 40 (3.2) (P < 0.0001) for MOAT scores, and 9.7 (1.5) vs 12 (1) (P < 0.001) for Checklist scores, respectively. Face and content validations showed excellent results among parameters evaluated, with an overall mean score of 4.8 (0.3) on 5. Cronbach's alpha was 0.96 and 0.83 for GRS and MOAT scores, respectively. Intraclass correlation coefficients for interrater reliability were excellent at 0.93, 0.92, and 0.89 for the GRS, MOAT, and Checklist scores, respectively. This study proves the construct simulator to be valid and the assessment scales to be reliable.

The Montreal Augmentation Mammoplasty Operation (MAMO) Simulator: An Alternative Method to Train and Assess Competence in Breast Augmentation Procedures

Surgical residents' exposure to aesthetic procedures remains limited in residency training. The development of the Montreal Augmentation Mammoplasty Operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. To perform face, content and construct validations of the MAMO simulator for subpectoral breast augmentation procedures and assess the reliability of the assessment scales used. Plastic surgery staff and residents were recruited to perform a subpectoral breast augmentation on the simulator. Video recordings of their performance were blindly evaluated using the Objective Structured Assessment of Technical Skills (OSATS) system consisting of the Global Rating Scale (GRS), Mammoplasty Objective Assessment Tool (MOAT) and a surgery-specific Checklist score. Fourteen plastic surgery residents and seven expert plastic surgeons were enrolled. Experts' performance was significantly higher than residents' according to each of GRS, MOAT and Checklist scores. Mean values of residents and experts were 23.4 (2.5) vs. 36.9 (3.1) (p<0.0001) for GRS score, 30.4 (2.2) vs. 40 (3.2) (p<0.0001) for MOAT scores and 9.7 (1.5) vs. 12 (1) (p<0.001) for Checklist scores, respectively. Face and content validations showed excellent results among parameters evaluated, with an overall mean score of 4.8 (0.3) on 5. Cronbach's alpha was 0.96 and 0.83 for GRS and MOAT scores, respectively. Intraclass Correlation Coefficients for interrater reliability were excellent at 0.93, 0.92, and 0.89 for the GRS, MOAT, and Checklist scores, respectively. This study proves the construct simulator to be valid and the assessment scales to be reliable.

Abstract: A Randomized Placebo-Controlled Double Blind Study of Intercostal Nerve Block Versus Incisional Infiltration with Bupivacaine for Postoperative Pain Control after Subpectoral Breast Augmentation

INTRODUCTION: Breast augmentation is among the most popular surgery procedures performed in the Asian countries. Adequate pain control can have a substantial impact on morbidity and patient satisfaction. To date, no standard of care exists and management is based on surgeon preferences. The purpose of our study is to examine the role of intercostal nerve block and local bupivacaine injection in pain management following subpectoral breast augmentation. METHODS: This study was a prospective, randomized, placebo controlled double blind clinical trial with ethical approval. Thirty-two consecutive women undergoing subpectoral breast augmentation were enrolled. Patient received general anesthesia and were allocated randomly to two study groups. Patient in group 1 received intercostal nerve block using 10 ml of 0.25% bupivacaine with epinephrine in one side of the breast and normal saline in another side prior to implant placement. Patient in group2 received locally administered of 20 ml of 0.25% bupivacaine with epinephrine at the surgical site in one side of breast and placebo infiltration of normal saline in the contralateral breast. Both the patient and evaluator were blinded to the side given anesthesia and method of anesthesia used. Primary outcome was pain measured with the visual analogue scale recorded at 2, 6, 12, 24 and 48 hours at rest and after movement. Pain score was compared between breasts (anesthesia vs placebo) and between types of anesthesia. By comparing analgesic outcomes in the same patients, we could control for the subjectivity of pain assessments. A p-value of < 0.05 was considered statistically significant. RESULTS: Postoperative pain gradually decreased with time in all patients. No difference in pain scores was found over time at rest or on movement when comparing Intercostal nerve block to placebo or local infiltration to placebo. There was also no statistically significant difference in pain between intercostal nerve block and local infiltration of bupivacaine. All patients can return to normal activities within 48 hours after surgery. CONCLUSION: Our study did not demonstrate any statistically significant difference in postoperative pain when comparing those receiving intercostal nerve block versus placebo and those receiving local administered bupivacaine versus placebo. No beneficial effect of reducing postoperative pain demonstrated regardless of the type of local anesthetic used.

The Supra-Inframammary Fold Approach to Breast Augmentation: Avoiding a Double Bubble.

This retrospective study evaluated 160 consecutive women undergoing primary subpectoral breast augmentation. An incision was made 0.5-1.0 cm above the IMF. Dissection proceeded directly to the pectoralis margin, preserving IMF fascial attachments. The pectoralis origin was released from the lower sternum. Surveys were administered to obtain patient-reported outcome data. Ninety-eight patients (61%) participated. Implants often appear high on the chest at early follow-up appointments but gradually settle. One patient (0.6%) developed a double bubble. No reoperations were needed for implant malposition. One patient had a mild animation deformity. There were no cases of symmastia. The mean result rating was 9.1/10. Four percent of surveyed patients found their implants too high; 8% found them too low. Ninety-two patients (94%) reported that their scars were well-hidden. Ninety-six women (98%) said that they would redo the surgery. A supra-IMF approach anticipates the normal descent of implants after augmentation. Scars remain hidden both in standing and supine positions. This method reduces the short-term risk of reoperation for implant malposition or a double bubble.

Efficacy of ultrasound, mammography and magnetic resonance imaging in detecting breast implant rupture: A retrospective study of 175 reconstructive and aesthetic sub-pectoral breast augmentation cases

To date, the effectiveness of radiological imaging in detecting silicone breast implant rupture is uncertain. The purpose of this study is to retrospectively evaluate the effectiveness of radiological imaging when diagnosing a rupture. In this study, 175 patients with 242 breast implants were included, of which 168 and 74 implants were used for breast reconstruction and aesthetic augmentation, respectively. All patients who underwent revision surgery, between January 2015 and June 2016, following breast augmentation or reconstruction were included, regardless of any pre-operative diagnosis of rupture that had been made. The diagnosis of intracapsular rupture was verified intraoperatively and compared to the pre-operative findings. With regard to pre-operative diagnostic imaging methods, we compared magnetic resonance imaging (MRI), mammography, and ultrasonography (US) findings. Among the 242 implants that were explanted, 35 clinical ruptures were confirmed and compared with the related radiological findings. We reported 22 false positives and 15 false negatives. US was the least specific and least accurate method because of its lowest positive predictive value (PPV) and negative predictive value (NPV). Mammography was the most specific and most accurate method, with the highest PPV (96%). Surprisingly, MRI was the most sensitive; however, it was neither the most specific nor the most accurate method despite having the highest NPV (98%). After comparing these three radiological techniques, we conclude that US along with MRI can be useful for young patients. Mammography, which was characterised by high specificity and accuracy, could be useful along with MRI in investigating patients over the age of 40.

An Oncoplastic Breast Augmentation Technique for Immediate Partial Breast Reconstruction following Breast Conservation.

Patients with a small breast volume and a relative large lumpectomy volume are at risk of developing severe breast deformity and asymmetry following breast conservation, presenting a unique surgical challenge. A series of patients undergoing immediate reconstruction by means of an oncoplastic breast augmentation technique following breast conservation are described. The technique includes local tissue rearrangement and bilateral subpectoral breast augmentation with implants of different sizes and shapes, immediately after lumpectomy for a malignant tumor. Twenty-one consecutive patients underwent the oncoplastic breast augmentation technique (mean follow-up, 23 months; range, 12 to 48 months). Three patients (14.3 percent) had tumor-positive surgical margins. Postoperative complications included grade III/IV capsular contracture in five patients (23.8 percent) and breast infection in two patients (10 percent). All patients received postoperative radiation therapy. The cosmetic outcome was evaluated at least 6 months after radiation therapy, and it was favorable according to the reported high patient satisfaction (81 percent) and independent observers' evaluation scores (76 percent). The oncoplastic breast augmentation technique described in this article is an acceptable option in small-breasted patients with a relatively large lumpectomy volume who elect to undergo breast conservation. This technique allows conservation of the affected breast and minimizes potential breast deformation and asymmetry following radiation therapy. Therapeutic, IV.