[Optimization of primary aesthetic breast augmentation using implants: an evidence-based level approach]

Intraoperative instillation of ropivacaine during the placement of sub-muscular cosmetic breast implants: Is there a clinical benefit?

INTRODUCTION

The sub-muscular placement of cosmetic breast implants leads to substantial pain due to the muscular distention. The aim of this study was to assess the efficiency of intraoperative ropivacaine instillation to reduce postoperative pain the day after surgery.

MATERIAL AND METHODS

We conducted a prospective, controlled, single-blinded study comparing the intraoperative instillation of 7.5mg of ropivacaine through Redon drains with the standard procedure in 72 patients undergoing sub-muscular cosmetic breast augmentation for the first time.

RESULTS

Pain at the awakening on postoperative day 1 was 4.8 on a simple numeric pain scale in the treatment group and 5.1 in the control group (P>0.05). On postoperative day 3, pain at awakening was 3.7 in both groups (P>0.05), and on postoperative day 5, pain was 2.8 in the treatment group and 2.7 in the control group (P>0.05).

CONCLUSION

Local instillation of ropivacaine in the implant pocket during surgery did not decrease postoperative pain on day 1, day 3 and day 5. From now on, we are able to tell to patients that the postoperative pain after sub-muscular cosmetic breast implants surgery is about 5/10 on postoperative day 1, 4/10 at day 3 and 3/10 at day 5.

LEVEL OF EVIDENCE

Level II.

[Delay of professional activity recovery after implant based breast augmentation surgery: Influence of healthcare coverage]

AIM OF THE STUDY

The main goal is to determine if the delay before going back to work after implant-based breast augmentation surgery is influenced by the healthcare coverage criteria.

MEANS AND METHODS

In this retrospective, single center based study, patients who underwent implant-based breast augmentation surgery (excluding reconstructive surgery) in the past 3 years with a minimum follow-up of 1 month were questioned by telephone. Patients who had early postoperative complications, or no professional activity, were excluded. The demographic and perioperative data were collected and two groups were compared: those who were covered by the healthcare system and those who were not.

RESULTS

Sixty patients were included. The two groups were comparable concerning the demographic (age, BMI, children, work intensity, smoking status, comorbidity) and surgical data (surgical approach, type, volume and position of the implant, operative time and drainage). There was a significant difference between the groups concerning the delay of return to work (P=0.0001): 18.4 days for reimbursed patients versus 9.45 days for patients without healthcare coverage.

CONCLUSION

For the same implant-based breast augmentation surgery, and for the same population, the duration of postoperative recovery period doubles for the patients for whom surgery is reimbursed by the healthcare system.