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Pezone G, Cavaliere A, Nele G, D'Andrea F, Schonauer F. Betadine-soaked gauzes intraoperative sizing in breast augmentation surgery. JPRAS Open 2023; 36:89-93. [PMID: 37215685 PMCID: PMC10196793 DOI: 10.1016/j.jpra.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/26/2023] [Indexed: 05/24/2023] Open
Abstract
In breast augmentation surgery, the correct evaluation of the implant size required is crucial to achieve satisfactory final result. Intraoperative volume decision is usually made by the use of silicone gel breast sizers. Intraoperative sizers have some disadvantages: the progressive loss of structural integrity, the increased risk of cross infection, the high costs. However, during breast augmentation surgery, it is mandatory to fill and expand the newly dissected pocket. In our practice we fill the dissected space with Betadine-soaked and then squeezed gauzes. The use of multiple soaked gauzes as sizers is advantageous for the following reasons: they fill and expand the pocket, they are useful to check the volume and to show the circumferential contour of the breast, to keep the pocket clean while dissecting the second one, to check final hemostasis and to compare the two breasts' size before definitive implant insertion. We simulated an "intra operative setting" where standardized volume Betadine-soaked gauzes were packed into a breast pocket. This easily reproducible and accurate technique is inexpensive and produces reliable and highly satisfactory results; it can be incorporated into the practice of any surgeon performing breast augmentation. Evidence Based Medicine (EBM) level: IV.
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Affiliation(s)
- Giuseppe Pezone
- Unit of Plastic Surgery, University “Federico II” , Via Sergio Pansini, 5, Napoli, Naples 80131, Italy
| | - Annachiara Cavaliere
- Unit of Plastic Surgery, University “Federico II” , Via Sergio Pansini, 5, Napoli, Naples 80131, Italy
| | - Gisella Nele
- Ruesch Private Hospital, , Viale Maria Cristina di Savoia, 39, Napoli, Naples 80122, Italy
| | - Francesco D'Andrea
- Unit of Plastic Surgery, University “Federico II” , Via Sergio Pansini, 5, Napoli, Naples 80131, Italy
| | - Fabrizio Schonauer
- Unit of Plastic Surgery, University “Federico II” , Via Sergio Pansini, 5, Napoli, Naples 80131, Italy
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Malter W, Bachmann BJ, Krug B, Hellmich M, Zinser M, Mallmann P, Eichler C, Puppe J. Correlation analysis of resected breast tissue and implant volume after mastectomy and its association with breast density. Arch Gynecol Obstet 2021; 305:169-177. [PMID: 34189629 PMCID: PMC8782773 DOI: 10.1007/s00404-021-06128-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The current methods for calculating the ideal implant volume for breast reconstruction are based on pre- or intraoperative volume measurements of the existing breast volume and do not take into account the individual breast density of the woman. This study aims is to identify objective parameters that can help to improve the optimal implant selection. MATERIALS AND METHODS This retrospective analysis includes 198 breast cancer patients who underwent mastectomy. Breast densities (ACR) measured in mammography and MRI were compared with the removed breast tissue weight and volume of the implants used. In addition, the resected weight was compared directly with the implant volume to calculate a mathematical function. RESULTS There was no significant correlation between the ACR values and the resected weights [correlation coefficient: mammography:- 0.117 (p = 0.176), MRI - 0.033 (p = 0.756)]. A negative correlation between the implant volumes and both imaging methods could be demonstrated [correlation coefficient: mammography - 0.268; p = 0.002; MRI was - 0.200 (p = 0.055)]. A highly significant correlation between the resected weights and the implant volumes (correlation coefficient 0.744; p < 0.001) was observed. This correlation corresponds to a power function (y = 34.71 x0.39), in which any resected weight can be used for the variable x to calculate the implant volume. CONCLUSION We were able to show that there is a significant correlation between the resected breast tissue and the implant volume. With our novel potency function, the appropriate implant volume can be calculated for any resected weight making it easier for the surgeon to choose a fitting implant in a simple and more objective manner.
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Affiliation(s)
- Wolfram Malter
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Cologne, Germany.
| | - Bo Jan Bachmann
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Barbara Krug
- Department for Diagnostic and Interventional Radiology¸ Medical Faculty, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Max Zinser
- Department for Plastic and Reconstructive Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Christian Eichler
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Julian Puppe
- Department of Gynecology and Obstetrics, Medical Faculty, University of Cologne, Cologne, Germany
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Ishii N, Tani Y, Kiuchi T, Uno T, Ando J, Kishi K. Optimal intraoperative selection of the projection of silicone breast implant using simplified cotton sizers. Gland Surg 2019; 8:537-541. [PMID: 31741884 DOI: 10.21037/gs.2019.10.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background It is occasionally difficult to accurately measure the projection of the unaffected breast in unilateral breast reconstruction and decide the optimal projection of a silicone breast implant (SBI). SBI ready-made sizers are useful for selecting the optimal SBI; however, the cost of procuring multiple types of this ready-made sizers is high. Therefore, we aimed to develop a novel technique for selecting SBIs using simplified cotton sizers, intraoperatively. Methods We applied the novel technique on 15 patients who underwent SBI-based breast reconstruction after simple mastectomy, among whom two or three SBI candidates had similar height and width but different projection. The breast reconstructed using a cotton SBI sizer was compared with the unaffected breast in the sitting position. We then selected the optimal SBI with a little higher projection than that of the unaffected breast. At the postoperative 1 year, we confirmed whether we could select better SBI among the prepared SBIs. Results Creating and applying the cotton SBI sizer required approximately 10 min in all cases. Optimal SBI selection among the prepared SBIs was seen in 14 cases; capsule contracture occurred in 1 case. Conclusions A simplified cotton SBI sizer is recommended because it is easy and inexpensive to develop and provides reliable assistance in identifying the optimal SBI projection.
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Affiliation(s)
- Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, Japan
| | - Yumiko Tani
- Department of Plastic and Reconstructive Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya City, Tochigi, Japan
| | - Tomoki Kiuchi
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, Japan
| | - Takahiro Uno
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, Japan
| | - Jiro Ando
- Department of Breast Surgery, Tochigi Cancer Center, Utsunomiya City, Tochigi, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
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A Novel Method for Intraoperative Breast Implant Pocket Assessment: Air Augmentation. Arch Plast Surg 2017; 44:354-355. [PMID: 28728338 PMCID: PMC5533052 DOI: 10.5999/aps.2017.44.4.354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022] Open
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Matching the Implant to the Breast: A Systematic Review of Implant Size Selection Systems for Breast Augmentation. Plast Reconstr Surg 2017; 138:987-994. [PMID: 27782989 DOI: 10.1097/prs.0000000000002623] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND For primary breast augmentation, several implant selection systems have been described to guide the surgeon with choosing from a variety of manufactured implant dimensions and properties. Controversy exists regarding the most efficacious method of selecting an appropriate implant size that best matches the patient's breast. METHODS The goal of this systematic review was to provide a comprehensive list of documented implant size selection systems, and to critically evaluate them. Implant size selection systems were grouped into categories based on selection principles. Articles were evaluated based on reported outcome measures and methodologic quality. RESULTS Thirty-three implant size selection systems were included in the final analysis. Only 12 percent of articles (four of 33) reported clinical outcomes that could be compared to accepted literature values or industry standards. Articles that described tissue-based planning systems, which use clinical guidelines to determine the optimal patient-specific implant dimensions, were of highest methodologic quality using the Methodological Index for Non-Randomised Studies scale, when compared to systems that used breast "dimensional" analyses that stress tissues to the desire of the patient and/or surgeon, and compared to systems that did not use breast measurement (means ± SD, 6.0 ± 1.4, 1.4 ± 2.3, and 0.0 ± 0.0, respectively). CONCLUSIONS There is some evidence to support tissue-based planning as a superior approach to implant size selection planning; studies that used tissue-based planning reported lower reoperation rates compared with industry standards and accepted literature values. The authors offer several suggestions on how to improve the methodologic quality of future studies describing new implant selection systems.
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Baek WY, Byun IH, Kim YS, Lew DH, Jeong J, Roh TS. Patient Satisfaction with Implant Based Breast Reconstruction Associated with Implant Volume and Mastectomy Specimen Weight Ratio. J Breast Cancer 2017; 20:98-103. [PMID: 28382100 PMCID: PMC5378585 DOI: 10.4048/jbc.2017.20.1.98] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose Breast volume assessment is one of the most important steps during implant-based breast reconstruction because it is critical in selecting implant size. According to previous studies, there is a close relationship between the mastectomy specimen weight and resected breast volume. The aim of this study was to evaluate long-term patient satisfaction with implant-based breast reconstruction guided by the ratio of implant volume to mastectomy specimen weight. In doing so, we describe the ideal ratio for patient satisfaction. Methods A total of 84 patients who underwent implant-based breast reconstruction for breast cancer were included in this study. The patients were grouped by the ratio of implant size to mastectomy specimen weight (group 1, <65%; group 2, 65%–75%; and group 3, >75%). Outcome analysis was performed using a questionnaire of patient satisfaction and the desired implant size. Results Patient satisfaction scores concerning the postoperative body image, size, and position of the reconstructed breast were significantly higher in group 2. The average ratio of the ideal implant volume to mastectomy specimen weight for each group was 71.9% (range, 54.5%–96.7%), with the differences across the three groups being not significant (p=0.244). Conclusion Since there is an increase in breast reconstruction, selecting the appropriate breast implant is undoubtedly important. Our novel technique using the ratio of implant volume to mastectomy specimen weight provides physicians a firm guide to intraoperative selection of the proper implant in reconstructive breast surgery.
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Affiliation(s)
- Woo Yeol Baek
- Institute of Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il Hwan Byun
- Institute of Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Institute of Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyun Lew
- Institute of Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Tai Suk Roh
- Institute of Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
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Does the Use of Intraoperative Breast Sizers Increase Complication Rates in Primary Breast Augmentation? A Retrospective Analysis of 416 Consecutive Cases in a Single Institution. PLASTIC SURGERY INTERNATIONAL 2016; 2016:6584810. [PMID: 27092273 PMCID: PMC4820630 DOI: 10.1155/2016/6584810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 03/01/2016] [Indexed: 11/18/2022]
Abstract
Background. Is the use of intraoperative breast sizers beneficial for plastic surgeons or do they result in higher complication rates? Methods. This is a retrospective study of 416 consecutive cases of primary breast augmentation with silicone implants at the Plastic Surgery Service of Professor Ivo Pitanguy at the 38th Infirmary Santa Casa Misericórdia Hospital, Rio De Janeiro, from January 2011 to March 2014. 212 cases (51%) were carried out with use of intraoperative breast sizers with 204 cases (49%) without the use of implant sizers. This study compares the outcome of cases that employed the use of intraoperative implant sizers versus those that did not in terms of infection, hematoma/seroma formation, and capsular contracture. Results. Of 416 primary breast augmentation cases, there were 5 cases of infection (1.2%), 4 cases of seroma (1%), 3 cases of hematoma (0.7%), and 7 cases of capsular contracture (Baker's Grade III/IV)(1.7%). Total complication rate limited to infection, seroma, hematoma, and capsular contracture was 1.15% (95% CI 0.96-1.93%). There was a significant difference in the scores for breast sizers (M = 4.3, SD = 1.4) and no breast sizers (M = 2.3, SD = 0.87) conditions, t(8) = 2.79, p = 0.018. The use of implant sizers was correlated with a higher complication rate. Conclusion. Good results could be obtained without the use of breast sizers in primary breast augmentation with use of a biodimensional tissue based planning system while eliminating risks of infection and reducing intraoperative time. Notwithstanding, in a residency program breast sizers can be an excellent training tool to shorten the learning curve in the novice surgeon.
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Khan L, Oni G, Griffiths M. A simplified method of sizing testicular prosthesis. Ann R Coll Surg Engl 2015; 98:69. [PMID: 26688407 DOI: 10.1308/rcsann.2016.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- L Khan
- Mid Essex Hospital Services NHS Trust , UK
| | - G Oni
- Mid Essex Hospital Services NHS Trust , UK
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McMahon D, Lin A, Reddy V, Gruber RP. Rhinoplasty sizers. Aesthetic Plast Surg 2012; 36:72-6. [PMID: 21938594 DOI: 10.1007/s00266-011-9764-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 09/04/2011] [Indexed: 10/18/2022]
Abstract
Templates and sizers are used as tools to assist in the design and construction of both structural and artistic works. These templates and sizers are used frequently in the field of aesthetic and reconstructive surgery. The use of a template to assist with construction of cartilage grafts in rhinoplasty allows the surgeon to sculpt by replicating the template model. Templates and sizers are useful and advantageous tools in the rhinoplasty operation.
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