Undergone Augmentation Mammoplasty Research Articles

Evaluation of different breast implants for rupture and durability after implantation

<br><b>Aim:</b> This study includes the evaluation of 84 implants removed after an average of 10 years from 42 patients who underwent augmentation mammoplasty and augmentation mastopexy at various centers over a 20-year period. <b>Patients and Methods:</b> Implants from patients who were all women aged between 28-60 years were evaluated after an average of 10 years following breast implantation. Preoperative physical examination, ultrasound examination and magnetic resonance imaging (MRI) were performed. Breast implants were removed from 42 patients for various reasons. The capsules and the free fluid removed with the implants underwent pathological and cytological evaluation. 84 implants that were removed were evaluated and scored for rupture, gel leakage, presence of air in the gel, changes in shell structure, and base deformities. Implants without any deformity were given a full score of 10, while score reduction was made according to various types of deformities seen in other implants. The average score of each implant brand was compared to other brands. <b>Results:</b> Rupture was observed in 23 of a total of 84 implants, while implant deformities such as gel leakage, air presence in the gel, decreased elasticity, base deformity and thinning of the shell were also present. Among all, 16 implants received a full score. The durability of the implants in the human body and the damage they received were classified according to their scores. Those with a score of eight and above were classified as high, those with a score between 6-8 were classified as medium, and those with a score of less than six were classified as implants with low endurance. Most of the implants evaluated here had low to medium endurance. The volume of one of the ruptured implants was 200 mL, while the rest ranged from 275-400 mL. Bilateral rupture was observed in one patient with a McGhanR implant, which had stayed in the human body the longest (15 years). Apart from this, all ruptures in other cases were unilateral. In some of the implants of EurosiliconeR(three implants), McGhanR(two implants), NatrellaR(one implant), RofilR(one implant) and PolytechR(one implant), it was observed that the implant shell was completely torn, fragmented and disintegrated, and the gel was diffused into the capsule. Shell decay was much higher especially in EurosiliconeR, RofilR and McGhanR brands. The durability of the implants was classified according to their scores. High endurance implants were those with a score of eight and higher: MentorR, SilimedR, MotivaR, and ArionR. Medium endurance implants were those with a score between 6-8: EurosiliconeR, PolytechR, McGhanR, and NatrellaR. Low endurance implants were those with a score of six and lower: RofilR and PipR. Conclusions: Occurrence of rupture and various complications increase in implants especially after 10 years. Often from certain brands, particularly the high-volume implants, rupture more easily in time. Close follow-up should be planned for patients who have had implants for more than 10 years, considering the duration, implant brand and volume.<br>

Atypical rupture of a Poly Implant Prothése implant and fluid shifting: a case report

Women have undergone augmentation mammoplasty for decades, and if implant rupture is suspected, imaging modalities such as magnetic resonance imaging (MRI) and ultrasonography are available. The linguine sign, keyhole sign, and noose sign are all suggestive of rupture. However, earlier-generation implants with alternative filler materials demonstrate rupture signs that differ from those of today’s better-known implant materials. A 60-year-old female patient who had undergone augmentation mammoplasty 20 years ago presented with left breast swelling and pain in the lower-outer quadrant. Ultrasonography and MRI confirmed extracapsular diffuse wall enhancement with suspected, but not apparent, discontinuity in the patient’s left breast implant. Therefore, both implants were removed. It was determined that these were Poly Implant Prothése implants. The left breast implant differed from the contralateral implant in that it contained fluctuating fluid. This could be attributed to an osmotic gradient that caused the implant to swell and weakened the elastomer shell, resulting in micro rupture without a gross tear. Patients who undergo augmentation mammoplasty should have regular follow-up examinations, even if there are no symptoms. Furthermore, clinicians should be aware that some patients who have had breast augmentation mammoplasty may experience atypical symptoms and signs if the implant ruptures.

Augmentation Mammoplasty With External Volume Expander–Assisted Autologous Fat Grafting in 305 Asian Patients

External volume expander (EVE)-assisted autologous fat grafting is suitable for breast augmentation, but no large sample study in Asia has confirmed this method. The authors reported their experience and outcomes in augmentation mammoplasty with EVE-assisted autologous fat grafting. A retrospective study was conducted in 305 female patients who underwent augmentation mammoplasty with EVE-assisted fat grafting between September 2012 and December 2020. Doctors utilized Crisalix (Crisalix S.A., Lausanne, Switzerland) for 3-dimensional (3D) imaging acquisition to measure the increase in breast volume to evaluate doctor satisfaction. The Preoperative Satisfaction with Breast and BREAST-Q questionnaires were employed to assess patients' preoperative and postoperative satisfaction, respectively. The 305 female patients were aged 18 to 50 years (mean, 35.9 years). Among them, 68.52% were "very satisfied," 18.69% were "somewhat satisfied," 11.15% were "somewhat dissatisfied," and 1.64% were "very dissatisfied" based on BREAST-Q analysis, whereas 100% were dissatisfied according to the Preoperative Satisfaction with Breast questionnaire. Doctors employed Crisalix to measure the increase in breast volume to evaluate doctor satisfaction. The results showed 76.01% had an increase in breast volume of 150 to 250 mL or >250 mL and were "satisfied" and "very satisfied," respectively, 21.64% had an increase of 50 to 149 mL and were "somewhat satisfied," and 2.30% had an increase <50 mL and were "dissatisfied." There were no complications, such as obvious fat liquefaction, infection, or fat embolism. Augmentation mammoplasty with EVE-assisted fat grafting is effective and satisfying in China. Crisalix for 3D imaging acquisition is convenient and effective in measuring breast volume.

Retrospective multicenter cohort analysis of 621 cases of BellaGel silicone breast implants with study of physicochemical properties and surface topography

This study aimed to assess the effectiveness and safety of BellaGel implants after implantation in Asian women and inform surgeons of another option for use in breast augmentation and reconstruction. This study was conducted in eight hospitals from November 27, 2015 to April 30, 2018. All patients underwent augmentation mammoplasty or implant-based breast reconstruction with BellaGel implants. Complication rates were compared between groups, and the cumulative hazard function was compared using the Kaplan-Meier survival analysis. Implants were grouped by surface type, and the cumulative hazard functions of total complication cases were compared. The biomechanical properties of the BellaGel implant and other company representative implants were tested using a mechanical testing machine, and surface topography was analyzed using a 3D laser scanning confocal microscope. There was a significant difference in the incidence of complications between the reconstruction (17.1%) and augmentation (4.7%) groups, but no significant difference in the complication rates of each group. There was no difference in the reoperation or revision rates between the groups. The log rank test showed a statistically significant difference in cumulative hazard function between the groups. Among the three types of implants (smooth, textured, and microtextured), the microtextured type had the lowest complication rate. The BellaGel microtexture implant had the highest maximal tensile load and displacement value. The BellaGel and Silksurface implants had the highest stored energy, although there was no significant difference. BellaGel implants can serve as a criterion for the selection of safe and effective implants among currently available implants.

Nipple Dimensions After Augmentation Mammoplasty, Mastopexy and Reduction Mammoplasty: A Comparative Clinical Study.

Nipple hypertrophy is a rare aesthetic problem. Ideal nipple dimensions are 6-8mm, while nipples larger than 10mm are considered hypertrophic. A total of 24 female patients, aged between 22 and 53years, with a nipple diameter or height greater than 10mm, underwent augmentation mammoplasty (AM), augmentation mastopexy (AUM) and reduction mammoplasty (RM) operations. The patients were divided into three groups according to the type of surgery containing equal numbers of patients. Group I underwent AM, Group II underwent AUM and Group III underwent RM surgery. Preoperative and 1-year post-operative nipple dimension measurements were performed, and the results were compared. There was no significant difference between the preoperative nipple volumes among the groups (p > 0.05). There was no significant difference between preoperative and post-operative nipple volumes in Group I (p > 0.05). The difference between preoperative and post-operative nipple volumes in Group II and Group III was significant (p < 0.05). When post-operative dimension comparisons were taken into consideration, there was a significant difference between Group I compared to Group II and Group III (p < 0.05); however, the difference between Group II and Group III was not significant (p > 0.05). Since there will be no reduction in nipple size during the post-operative period in AM patients, hypertrophic nipple can be reduced in the same session. However, in patients with AUM or RM, if the reduction in nipple size is not sufficient, it is more convenient to perform the nipple reduction operation 1-year post-surgery. 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 .

SUN-051 Gender Dysphoria - Data from One Hundred Patients

Introduction: Gender dysphoria (GD) is a disease in which the patient's gender identity does not correspond to their biological gender. Traditionally, sex is assigned accordingly to the sexual organs as male or female, however these patients do not identify with this classification. A biological male who identifies himself as a female is referred to as transgender female or male to female GD (MtF) and a biological female who identifies herself as a male is referred to as a transgender male or female to male GD (FtM). In our center there is a multidisciplinary consultation to approach and follow up patients with GD. Our work is an analysis of the patients who are currently attending this consultation. Methods: Retrospective study of patients attending the Sexual Medicine Group Consultation with diagnosis of GD. Results: 100 patients diagnosed with GD, of which 65% had GD FtM and 35% MtF. The median age is 25 years (± 9.5 years). Regarding the onset of symptoms, 76% of patients report that it occurred in childhood (before age 10); 20% from 10 to 18 years old and only 4% reported having occurred after 18 years. The median age for starting treatment is at 22 years (± 7.5 years). About 83% of the patients start therapy on medical advice, the remaining are self-medicated; 86% of FtM GD patients are currently on testosterone therapy; 85% of MtF GD patients are on estrogen therapy and 71% on anti-androgens. Concerning co-morbidities: 22% of patients have depression; 39% smoke; 6% are HIV-infected; 4% dyslipidemia and 2% hypertension. 47 (47%) patients underwent at least one surgical treatment; the average time to the first surgery was 2 years. Of the FtM GD patients, 23 (35%) patients underwent mastectomy, 10 (15%) hysterectomy and oophorectomy and 3 (5%) neophaloplasty; of the MtF GD patients 8 (23%) underwent augmentation mammoplasty; 7 (20%) neovaginoplasty. Two patients had a family history of GD. One case of Klinefelter’s syndrome and one case of congenital adrenal hyperplasia was diagnosed during the study prior to therapy initiation.Discussion: There was a higher prevalence of FtM compared to MtF, unlike most centers reporting a higher prevalence of MtF. Regarding the proportion of patients on medical therapy, the data are in line with data from other centers already published, as well as the fact that most patients in our study are young. Conclusion: The demand for medical help from GD patients is increasing. The evaluation of these patients by endocrinology before and throughout treatment is essential, not only for the evaluation of contraindications or side effects of therapy, but also for the identification of endocrinological diseases. This is the first work, to our knowledge, to portray the case series of a consultation center dedicated to the treatment of patients with GD in Portugal.

Safe autologous rib harvest in patients with breast implants; technique and review

IntroductionAutologous rib harvest is a useful technique for rhinoplasty when septal cartilage is inadequate. For patients who have previously undergone augmentation mammoplasty, however, there is theoretical concern about the risk to breast implant integrity during costal cartilage harvest. The true risk to patients and their implants from autologous rib harvest is poorly studied. Herein, we review our technique and experience with autologous rib harvest after augmentation mammoplasty. MethodWe performed a retrospective review of patients who underwent autologous rib harvest after augmentation mammoplasty between February 1998 and February 2017 at a tertiary care hospital and private practice. We identified basic demographics, implant type, approach to implantation, and any post-operative complications following rib harvest. Surgery was performed using an inframammary approach with a boat-technique for cartilage harvest. ResultsA total of 109 individuals, aged 19-64, were included in our study. There was a 2% rate of post-operative seroma development; no patients developed long-term complications. There was a 5% rate of incidental intraoperative discovery of implant dehiscence or implant entry, all of which were repaired primarily at the time of surgery, and none of which developed post-operative sequelae. There were no cases of pneumothorax, post-operative breast malposition, or other major complications. ConclusionHerein, we present the largest cohort of patients to undergo autologous rib harvest after augmentation mammoplasty. Routine intra-operative drain placement and perioperative imaging is unnecessary. Our technique allows harvest of a suitable amount of cartilage, is very cosmetically acceptable to this cosmetically-conscious population, and is safe for patients and their implants.

Incidence and Classification of Chest Wall Deformities in Breast Augmentation Patients.

Although chest wall deformities (CWDs) are seen four times more often in males than in females, most patients who consult plastic surgery clinics in our country are females. Breast augmentation and augmentation mastopexy were performed with a total of 812 breast implants in 406 patients. Forty-three of these patients had various CWDs. The CWD patient ages ranged from 18 to 43years. Patients were observed for 6months to 8years (mean of approximately 3years). Pectus excavatum (PE) was present in 22 patients, pectus carinatum (PC) in five patients, Poland syndrome (PS) in two patients, sunken chest deformity (SCD) in three patients, barrel chest deformity (BCD) in five patients, body builder deformity (BBD) in three patients, and long upper chest wall (LCW) in three patients. None of the patients had functional or cardiac deformities. A total of 86 round, anatomically textured gel implants in various profiles were used within a range of implant volumes for all patients. There were no serious complications in the 43 CWD patients. The frequency of CWDs in the total population of 406 patients was approximately 10.6%. PE was present in 51% (22/43) of the patients with CWDs. The deformity rates among patients who underwent augmentation mammoplasty were as follows (%): PE, 5.4; PC, 1.23; PS, 0.5; SCD, 0.73; BCD, 1.23; BBD, 0.73; and LCW, 0.73. The three most common deformities observed in this study were PE, PC, and BCD. The least common deformity was PS. Patients with CWDs should be carefully evaluated preoperatively, and all the associated measurements and calculations must be meticulously performed. The implant selection may differ according to the deformity pattern. For example, in patients with PE, prostheses with larger base diameters cover the deformity better. Although high-profile prostheses are preferred on the affected side in cases of PS and SCD, low- or middle-profile prostheses are preferred on the opposite side. Despite this common consensus, there was an asymmetry of approximately 1cm between the sides, as observed postoperatively. However, the patients did not express dissatisfaction with this situation. Low-profile prostheses should be preferred for PC and BCD protruding CWDs because asymmetry becomes more prominent and over-projection occurs more frequently in cases of high-profile prostheses. The BBD projection is also a problem. For this reason, high-profile prostheses should be preferred in these patients. It is possible to obtain satisfactory results by using appropriate breast implants in patients with CWDs. Level of Evidence IV 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 .

Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients.

BackgroundThe current indications of cardiac implantable electronic devices (CIEDs) have expanded to include young patients with serious cardiac risk factors, but CIED placement has the disadvantage of involving unsightly scarring and bulging of the chest wall. A collaborative team of cardiologists and plastic surgeons developed a technique for the subpectoral placement of CIEDs in young female patients via a transaxillary approach.MethodsFrom July 2012 to December 2015, subpectoral CIED placement via an axillary incision was performed in 10 young female patients, with a mean age of 25.9 years and mean body mass index of 20.1 kg/m2. In the supine position, with the patient's shoulder abducted, an approximately 5-cm linear incision was made along one of the deepest axillary creases. The submuscular plane was identified at the lateral border of the pectoralis major, and the dissection continued over the clavipectoral fascia until the subpectoral pocket could securely receive a pulse generator. Slight upward dissection also exposed an entrance to the subclavian vein, allowing the cardiology team to gain access to the vein. One patient with dilated cardiomyopathy underwent augmentation mammoplasty and CIED insertion simultaneously.ResultsOne case of late-onset device infection occurred. All patients were highly satisfied with the results and reported that they would recommend the procedure to others.ConclusionsWith superior aesthetic outcomes compared to conventional methods, the subpectoral placement of CIEDs via a transaxillary approach is an effective, single-incision method to hide operative scarring and minimize bulging of the device, and is particularly beneficial for young female or lean patients.

Asian Breast Augmentation: A Systematic Review.

Background:Economic, cultural, and regulatory phenomena may explain recent popularization of implant-based augmentation in Asia; but the collective Eastern experience remains limited. Asian surgeons and their patients rely on evidence-based medicine that originates elsewhere and may not be entirely relevant. Distinct anatomic and cultural features of Asian women warrant a tailored approach to breast augmentation. We explore the Asian experience with a thorough exploration of the recent literature.Methods:A literature search was performed for articles written after 2000, of Asian women who underwent augmentation mammoplasty using MEDLINE, Embase, and Pubmed Databases. Technique and outcomes data were summarized.Results:Twelve articles reported outcomes of 2089 women. Korea contributed most series (English language, 7), followed by China (3), Taiwan (1), and Japan (1). Silicone implants were used in 82.1% of women studied, and almost exclusively after 2009. More round (68.9%) than anatomic implants (31.1%) were placed. Non-inframammary (axillary, areolar, and umbilical) incisions were used in 96.9% of cases. Nearly all implants were positioned below the muscle or fascia; subglandular placement accounted for 1.1% of cases. Implant/nipple malposition (1.3%), capsular contracture (1.9%), hematoma (0.6%), and infection (0.2%) rates were reported in most series. Undesirable scarring was the most frequent complication (7.3%), but was reported only in 4 of 12 series.Conclusions:Studies of Asian women undergoing augmentation mammoplasty are limited, often with ill-defined outcomes and inadequate follow-up. As experience accumulates, an expanding literature relevant to Asian women will provide evidence-based guidelines that improve outcomes and patient satisfaction, and foster innovation.

Desmoid Tumor Following Augmentation Mammoplasty with Silicone Implants

Desmoid Tumor Following Augmentation Mammoplasty with Silicone Implants

Treatment Algorithm of Galactorrhea After Augmentation Mammoplasty

Galactorrhea is a known complication of breast surgery, particularly reduction mammoplasty. However, in augmentation mammoplasty, it is a rare event. There are only a few case reports concerning galactorrhea after augmentation mammoplasty. In this report, we present a case of galactorrhea that occurred at 2 weeks postoperatively in a 34-year-old woman who had undergone augmentation mammoplasty with silicone implants via a transaxillary approach. Endocrinologic tests including serum prolactin level, routine blood work, and breast ultrasonography were all normal. The authors decided to manage conservatively with close observation. After 1 month, the symptom resolved without sequelae, and no recurrence has been reported.

Implantes mamarios y cáncer

The association between breast implants and cancer has been a controversial issue, due to the lack of evidence concerning the safety of these in the long term. The increase of the number of patients who have undergone augmentation mammoplasty and the detection of carcinogenic elements related to the mammary implants lit interest of the scientific community, on its possible association with the cancer. We consider to be very important, a review concerning the actual literature between breast implants and cancer. Some of the problems that have been raised about the use of breast implants are the modifications that are established for the execution of a physical exam, and also the difficulty to analyze a mammography, what makes us think of a delay in the detection of malignant pathology, and therefore a worse forecast and survival. Despite the stated above, several studies have demonstrated that there is no casual association between breast implants and cancer, and the suspicion by physical exam has been favored in the detection of suspicious masses; the stage and the size of the tumor have not presented major differences, in some cases tending to reduce its size. The mammography presents a reduction in its sensibility but it is possible to supplement by introducing combined projections and other image techniques in case of suspicion. The frequency and mortality do not face significant changes compared to the general population. Concerning the relationship between breast implants and extra mammary cancer, taking in consideration that the breast implant is a strange object susceptible to degeneration, capable of producing an immune response and migration of the content, a possible carcinogenic effect in neoplasms at distance is raised. Other studies can be witnessed describing a relation with some types of cancer, although by the existence of bias, these are not conclusive from a statistical point of view. Therefore, it is necessary to perform larger studies that detail in a more complete way the variables previous to the use of mammary implants, and with a better study methodology.

Accelerated Partial Breast Irradiation With Interstitial Brachytherapy for Women With Breast Cancer in the Presence of Breast Augmentation

Purpose: The number of women undergoing augmentation mammoplasty has increased 894% over the past 14 years. More women are being diagnosed with breast cancer in the presence of implants. By their nature, these women have demonstrated a personal priority on appearance and would lean towards breast conservation. However, the currently accepted treatment involves skin-sparing mastectomy and implant exchange. Breast-conserving therapy is usually avoided in augmented women for fear of causing capsular contraction, which occurs at a rate of 46–67% after whole breast irradiation.

Sepsis With Multiple Abscesses After Massive Autologous Fat Grafting for Augmentation Mammoplasty: A Case Report

Autologous fat grafting to the breast for breast reconstruction and cosmetic breast augmentation has gained much attention recently. However, its efficacy and the severities of its associated complications are of concern. The authors experienced one case of multiple breast abscesses after augmentation mammoplasty by autologous fat grafting. A 42-year-old woman presented to the authors' emergency department reporting tenderness, swelling, and a sensation of heat in both breasts. The patient had undergone augmentation mammoplasty by autologous fat grafting 7days previously. Abscess formation was suspected based on the patient's history, physical examination, laboratory findings, and image study. Incision and drainage were performed immediately with the patient under general anesthesia, and 500ml of a foul, brown, turbid, purulent fluid containing necrotic fat debris was drained from each breast. Empiric antibiotics were started on the first hospital day, and betadine and saline-irrigation were administered daily for 2weeks. Incisions were closed on hospital day 19 when laboratory data and local infection signs had improved. At the patient's 9-month follow-up assessment, breast contours were found to be well preserved, and scarring was minimal. Immediate complications such as edema, hematoma, and infection require serious consideration after autologous fat grafting in the breast. In particular, infection probably is the most serious complication because the volume of the fat injected is large and can induce systemic infections such as sepsis and distort the contours of the breast. To avoid such infections, systemic and multicenter studies are required to determine how fat grafting should be performed to minimize the risks of fat necrosis and infection.

Histopathological observation on the complications associated with augmentation mammoplasty by injection of polyacrylamide hydrogel

Objective To explore the histopathological changes in the breast after injection of polyacrylamide hydrogel (PAHG) and the possible causes of complications associated with PAHG augmentation mammoplasty. Methods The breast samples from 87 women, who had undergone PAHC augmentation mammoplasty in other hospitals or clinics and occurred complications, received repair surgery in our hospital. We examined the pathological changes in these breast tissues. Results The women injected with PAHG into the breast occurred complications clinically, including nodularity and lumps, gel migration, pain, and infection. The main histopathological changes in the mammary tissues taken from the majority of individuals with com-plication were integration and migration of PAHG within the fat, muscle and glandular tissues of the breast. The most marked findings (34/87, 39.08%) were foreign body reactions without prominent fibrosis or fibrous capsule. Destruction of glandular tissue and inflammatory changes could also be found in some patients (12/87, 13.8%). Carcinogenetic changes of the mammary gland were not found. Conclusions PAHG is a migratory material, which penetrates diffusely within the breast and not be fully absorbed. PAHG can induce foreign body reaction, which forms different histopathologic stages and can induce cell injury in the breast gland and the nearby muscular tissues. Key words: Mammoplasty; Polyacrylamide hydrogel; Complications; Histopathology

Autologous Fat Transplantation and Delayed Silicone Implant Insertion in a Case of Mycobacterium avium Breast Infection

Infection after breast augmentation is uncommon, occurring in 1-3% of cases. They are typically caused by bacterial skin flora, specifically Staphylococcus aureus and the coagulase-negative staphylococci. There have been infrequent reports of breast implant infection caused by the atypical mycobacteria. This report summarizes the case of a female patient who was infected by Mycobacterium avium after undergoing augmentation mammoplasty. This is the second case reported in the literature. Conservative recommendations include antibiotic therapy and removal of the implant until resolution of the infection or until healing of the wound. Salvage methods include one or more of the following: antibiotic therapy, debridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage. After removal of the implant and antibiotic therapy, autologous fat transplantation for correction of breast tissue depressions caused by the mycobacterium infection was done. Delayed bilateral breast augmentation by inserting polyurethane-covered silicone implants in subpectoral position and round block mastopexy to resect the periareolar scars were performed. Although this kind of complication has significantly compromised the aimed result and has caused frustration to both the patient and the physicians involved, we believe that the combination of autologous fat transplantation and delayed silicone implant insertion can be a safe strategy and can produce an acceptable aesthetic result.

Prosthesis-preserving Mastectomy for Breast Cancer with Previous Augmentation Mammoplasty: Report of Two Cases

Augmentation mammoplasty is gaining wider and wider acceptance among Asian women, and has become more popular in Taiwan over the last two decades. The incidence of breast cancer is the same as that for non-augmented patients. Whether the prosthesis should be preserved or removed during mastectomy is still controversial. The aim of this study is to evaluate the strategy of preoperative assessment and the surgical plan for a breast cancer patient who has previously undergone augmentation mammoplasty. From November of 1997 to April of 2001, we experienced two breast cancer patients, who had undergone previous augmentation mammoplasty. Their ages were both 43; one had a history of mammoplasty for 10 years and the other for 9 months. Malignancy was diagnosed prior to the definitive surgical procedures; one patient had modified radical mastectomy and the other had partial mastectomy. The prostheses of both patients were preserved. There was no obvious post-operative complication and the recovery was as smooth as in non-augmented patients. The prosthesis remained in the same position and size. Both patients were satisfied with their functional results and aesthetic appearance. We present our successful experience in these two cases.

Lymphatic Mapping in Patients with Breast Cancer and Previous Augmentation Mammoplasty

Sentinel lymph node biopsy (SLNB) is now an established method of axillary staging in patients with breast cancer. However, the augmented breast poses an interesting challenge to this procedure. We hypothesized that SLNB is feasible in patients with augmented breasts who subsequently develop breast cancer. A retrospective study was performed from 1995 to 2006. Ten patients with augmented breasts underwent breast conservation therapy with SLNB. Sentinel lymph nodes were identified in all 10 patients. Three patients had positive sentinel nodes. Two patients proceeded to axillary lymph node dissection (ALND), and one declined. The subsequent ALND were negative for metastatic cancer. Seven patients had negative sentinel nodes. One patient with a negative sentinel node underwent ALND with all nodes negative for metastasis. Two patients were lost to follow-up. Of the remaining eight patients, the mean duration of follow-up was 71 months. None of these patients had evidence of axillary recurrence or distant metastasis at time of last follow-up. SLNB is a feasible method of axillary node staging in patients who have undergone augmentation mammoplasty who subsequently develop breast cancer. Further studies are needed to better determine the accuracy of lymphatic mapping in this patient population.

Effect of Bupivacaine (Marcaine) Injection into the Breast Pocket on Postoperative Pain in Patients Undergoing Augmentation Mammoplasty

Introduction: Bupivacaine (Marcaine) is known to be an effective local anesthetic agent. The question arises as to whether there is a role for placing this anesthetic into the breast implant pocket in breast augmentation surgery to achieve a greater degree of postoperative pain relief. The purpose of this study was to test the effectiveness of locally administered intraoperative bupivacaine into the breast pocket during augmentation mammoplasty. Materials and Methods: The study group consisted of 62 consecutive female breast augmentation patients ranging in age from 17 to 58 years. The clinical trial took place between December 2003 and March 2005 and was conducted in a prospective, randomized, double-blinded fashion using patient opinion on a postoperative pain scale rated from 1–10. Bupivacaine (150 mg) was placed into the implant pocket of the random test side after implant insertion, while no anesthetic was placed for the control group. Data were collected at time points of 0, 1, 3, and 6 hours after surgery as well as 1 week following surgery. The 0-hour data point was collected as soon as the patient was alert at the end of the procedure. Data were analyzed using paired t tests with the Bonferroni correction applied. Results: Based on the 10-point pain scale, the only statistically relevant difference occurred at the 1-hour postoperative time point, at which the mean pain level for the bupivacaine injected side was 3.0, while the mean pain level for the noninjected side was 4.2 with a P value of .01. There were no dropouts in the study. No hematomas or complications requiring reoperation were noted. Conclusion: The use of locally injected bupivacaine into the breast pocket during breast augmentation may be beneficial in alleviating some of the postoperative pain associated with augmentation mammoplasty.