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Hassan RAM, Urban CDA, Dória MT, Spautz CC, Rabinovich I, Anselmi KF, Schunemann E, Kuroda F, Sobreiro BP, Lima RSD. Exposed Implant after Immediate Breast Reconstruction - Presentation and Analysis of a Clinical Management Protocol. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:690-698. [PMID: 34670304 PMCID: PMC10183878 DOI: 10.1055/s-0041-1735939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. METHODS We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. RESULTS Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the original implant. CONCLUSION Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.
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Affiliation(s)
| | - Cícero de Andrade Urban
- Department of Post-graduation, Universidade Positivo, Curitiba, PR, Brazil.,Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | | | | | - Iris Rabinovich
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Paraná, PR, Brazil
| | | | - Eduardo Schunemann
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Paraná, PR, Brazil
| | - Flávia Kuroda
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
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Beidas OE, Rubin JP. Commentary: Mastopexy on Reconstructed Breast Following Massive Weight Loss: An Innovative Technique Using Dermo-Capsular Flaps. Aesthetic Plast Surg 2018; 42:400-401. [PMID: 29214335 DOI: 10.1007/s00266-017-1020-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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Cogliandro A, Barone M, Cassotta G, Salzillo R, Persichetti P. Mastopexy on Reconstructed Breast Following Massive Weight Loss: An Innovative Technique Using Dermo-Capsular Flaps. Aesthetic Plast Surg 2018; 42:396-399. [PMID: 29075821 DOI: 10.1007/s00266-017-0992-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND We have developed a dermo-capsular flap mastopexy technique for patients who have experienced massive weight loss after breast reconstruction. The aim of this technique is to lift the inframammary fold, adequately cover the implant, and remove excess skin, elevating the breast and obtaining symmetry with the contralateral breast. METHODS Between January 2014 and February 2017, we performed this technique on 20 women who were candidates for second-stage breast reconstruction following nipple-sparing mastectomy. All patients had experienced substantial weight loss (> 15 kg) and presented with ptosis after first-stage reconstruction. RESULTS There were 8 patients with bilateral reconstruction following bilateral mastectomy (4 with bilateral nipple-sparing mastectomy). There were 12 patients with unilateral mastectomy, all with contralateral breast ptosis treated by augmentation via inverted-T mastopexy (n = 7) or crescent mastopexy (n = 5). The average lift of the nipple-areola complex was 5 cm (range 2-8 cm). The average follow-up was 12 months (range 4-36 months). Two patients had complications, including partial wound dehiscence (in a heavy smoker) and recurrence of breast asymmetry. CONCLUSIONS Implant breast reconstruction after massive weight loss is still possible even in the setting of thin, ptotic, and anelastic breast tissue. Our inverted-T dermo-capsular flap mastopexy technique for reconstructed breast is safe and effective with good outcomes and high patient satisfaction. 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 .
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Affiliation(s)
- A Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
| | - M Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - G Cassotta
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - R Salzillo
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - P Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
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Munhoz AM, Marques ADA, Milanez JR, Gemperli R. Chest wall reconstruction following axillary breast augmentation and desmoid tumor resection using capsular flaps and a form-stable silicone implant: A case report, diagnosis and surgical technique. Int J Surg Case Rep 2017; 36:110-115. [PMID: 28554106 PMCID: PMC5447517 DOI: 10.1016/j.ijscr.2017.05.023] [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: 02/11/2017] [Revised: 05/14/2017] [Accepted: 05/15/2017] [Indexed: 01/09/2023] Open
Abstract
Desmoid tumors (DT) are a rare benign lesion, and chest desmoid tumors are much less frequent. A rare case of chest DT is presented and discussed. Chest DT following breast augmentation is very rare and few cases have been described; all have been related to the inframammary approach and located in the implant capsule. The authors describe a chest DT following subfascial axillary breast augmentation and subsequent surgical management and chest wall reconstruction. The case illustrates some aspects that may be useful for thoracic and plastic surgeons and may be used as guidance for surgical management.
Introduction Chest desmoid tumors (CDT) are rare lesions characterized by fibroblastic proliferation from the connective tissue. Although CDT have been studied previously, no cases following subfascial transaxillary breast augmentation (TBA) have been described. Presentation of case The authors describe a case of CDT in a 28-year-old woman one year after TBA, which presented as a painful and progressive mass in the lower-inner right breast quadrant. MRI showed a soft-tissue tumor (6 × 3 × 4 cm) that affected the region of the right anterior costal margin, without signs of structural costal invasion. Patient was treated surgically, exposing the right costal-sternal region through an inframammary approach and resecting the CDT. The remaining capsular flap was mobilized into the defect and a form-stable silicone implant was utilized to cover the chest wall defect and achieve an adequate breast contour. The patient is currently in 5th year after chest reconstruction, with satisfactory results. Neither the tumor or the symptoms recurred. Discussion CDT is an uncommon evolution following TBA. Although it is a rare disease, thoracic and plastic surgeons must be alert to avoid misdiagnosis. Defect reconstruction is necessary, mobilizing the capsular flaps and replacing the implants in order to obtain a satisfactory outcome. Conclusion Knowledge of this rare post-operative evolution is crucial, and early surgical intervention is warranted in order to avoid more aggressive treatment. This case report provides general knowledge of CDT, and may be used as guidance for early diagnosis and treatment.
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Affiliation(s)
| | | | - José Ribas Milanez
- Hospital Albert Einstein and Hospital das Clínicas University of São Paulo, Brazil
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Montemurro P, Cheema M, Hedén P, Avvedimento S, Agko M, Quattrini Li A. Autologous Collagen Matrix (ACM): Lower Pole Support With a Supero-Anterior Capsular Flap in Secondary Subpectoral Breast Augmentation. Aesthet Surg J 2017; 37:540-549. [PMID: 28333188 DOI: 10.1093/asj/sjw222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Secondary aesthetic breast surgery is a complex and challenging scenario. It requires the surgeon to identify contributing factors, provide patient education, make a further management plan, and optimize the conditions for a favorable result. Various techniques have been described in literature but the rate of reoperation is still high. The first author has been using a supero-anterior capsular flap with a neopectoral subcapsular pocket and an implant change in these cases. Objectives To review the patient characteristics, indications, and early results of using part of the existing implant capsule for secondary subpectoral breast augmentations. Methods All patients who underwent secondary breast augmentation, over a period of 2 years by the first author (P.M.), using the supero-anterior capsular flap technique were included. The technique involves dissection of a new subpectoral pocket and uses the existing implant capsule as an internal brassiere. Results A total of 36 patients were operated by this technique. Of these, 17 patients had developed a complication while 19 patients wanted a change in size only. At a mean follow up of 10.2 months, there was no bottoming out, double bubble, or capsular contracture. Conclusions This reliable technique provides stable results as shown by low rate of complications with the existing follow up. Level of Evidence 4
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Affiliation(s)
- Paolo Montemurro
- Drs Montemurro and Hedén are plastic surgeons in private practice in Stockholm, Sweden. Dr Cheema is a Plastic Surgeon and a Consultant, University Hospital, Birmingham, UK. Drs Avvedimento, Agko, and Quattrini Li are fellows at a private plastic surgical practice in Stockholm, Sweden
| | - Mubashir Cheema
- Drs Montemurro and Hedén are plastic surgeons in private practice in Stockholm, Sweden. Dr Cheema is a Plastic Surgeon and a Consultant, University Hospital, Birmingham, UK. Drs Avvedimento, Agko, and Quattrini Li are fellows at a private plastic surgical practice in Stockholm, Sweden
| | - Per Hedén
- Drs Montemurro and Hedén are plastic surgeons in private practice in Stockholm, Sweden. Dr Cheema is a Plastic Surgeon and a Consultant, University Hospital, Birmingham, UK. Drs Avvedimento, Agko, and Quattrini Li are fellows at a private plastic surgical practice in Stockholm, Sweden
| | - Stefano Avvedimento
- Drs Montemurro and Hedén are plastic surgeons in private practice in Stockholm, Sweden. Dr Cheema is a Plastic Surgeon and a Consultant, University Hospital, Birmingham, UK. Drs Avvedimento, Agko, and Quattrini Li are fellows at a private plastic surgical practice in Stockholm, Sweden
| | - Mouchammed Agko
- Drs Montemurro and Hedén are plastic surgeons in private practice in Stockholm, Sweden. Dr Cheema is a Plastic Surgeon and a Consultant, University Hospital, Birmingham, UK. Drs Avvedimento, Agko, and Quattrini Li are fellows at a private plastic surgical practice in Stockholm, Sweden
| | - Alessandro Quattrini Li
- Drs Montemurro and Hedén are plastic surgeons in private practice in Stockholm, Sweden. Dr Cheema is a Plastic Surgeon and a Consultant, University Hospital, Birmingham, UK. Drs Avvedimento, Agko, and Quattrini Li are fellows at a private plastic surgical practice in Stockholm, Sweden
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DeGeorge BR, Campbell CA. Techniques to refine the upper outer breast aesthetic subunit in alloplastic breast reconstruction: The lateral capsular flap. Plast Surg (Oakv) 2016; 24:83-8. [PMID: 27441190 DOI: 10.4172/plastic-surgery.1000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Lateral displacement of breast implants and axillary fullness are common causes of patient dissatisfaction and reoperation following prosthetic breast reconstruction. Suture plication of the capsule and acellular dermal matrix slings have been described to address lateral implant malposition, but with unacceptably high rates of recurrence and additional cost, respectively. OBJECTIVE To describe a novel technique using a lateral capsular flap to provide durable correction of implant malposition and, at the same time, redefinition of the lateral breast border, thereby restoring balance to the breast aesthetic subunits. METHODS Sixteen patients presented with lateral malposition of tissue expanders or breast implants during staged implant-based breast reconstruction, four of whom had additional unwanted axillary soft tissue fullness. An anteriorly based lateral capsular flap was performed for each breast to reconstruct the lateral border of the breast, return the implant to its appropriate position and address axillary fullness when indicated. RESULTS Lateral capsular flaps were performed for 16 patients (20 breasts) resulting in durable medial repositioning of the implant for a minimum of six months follow-up (range six to 60 months). Eight patients presented after implant placement with subsequent malposition while the remainder presented after tissue expander placement alone. For the eight patients with axillary fullness, elevation of the capsular flap allowed access to axillary contents for excision (four cases) or incorporation of axillary fat into the flap to prevent lateral implant palpability. No major complications, infectious complications or wound healing complications were reported. All patients showed satisfactory results, and reported high cosmetic and functional satisfaction with the appearance of their reconstructed breasts and axillary comfort. CONCLUSIONS In the authors' experience, the lateral capsular flap represents a simple, safe and reliable technique to correct breast implant lateral malposition, reconstruct the lateral breast border, and address unwanted axillary fullness in primary or revision implant-based breast reconstruction with improved cosmetic appearance and balance of the breast.
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Affiliation(s)
- Brent R DeGeorge
- Department of Plastic and Maxillofacial Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Christopher A Campbell
- Department of Plastic and Maxillofacial Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
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Degeorge BR, Campbell CA. Techniques to refine the upper outer breast aesthetic subunit in alloplastic breast reconstruction: The lateral capsular flap. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Lateral displacement of breast implants and axillary fullness are common causes of patient dissatisfaction and reoperation following prosthetic breast reconstruction. Suture plication of the capsule and acellular dermal matrix slings have been described to address lateral implant malposition, but with unacceptably high rates of recurrence and additional cost, respectively. Objective To describe a novel technique using a lateral capsular flap to provide durable correction of implant malposition and, at the same time, redefinition of the lateral breast border, thereby restoring balance to the breast aesthetic subunits. Methods Sixteen patients presented with lateral malposition of tissue expanders or breast implants during staged implant-based breast reconstruction, four of whom had additional unwanted axillary soft tissue fullness. An anteriorly based lateral capsular flap was performed for each breast to reconstruct the lateral border of the breast, return the implant to its appropriate position and address axillary fullness when indicated. Results Lateral capsular flaps were performed for 16 patients (20 breasts) resulting in durable medial repositioning of the implant for a minimum of six months follow-up (range six to 60 months). Eight patients presented after implant placement with subsequent malposition while the remainder presented after tissue expander placement alone. For the eight patients with axillary fullness, elevation of the capsular flap allowed access to axillary contents for excision (four cases) or incorporation of axillary fat into the flap to prevent lateral implant palpability. No major complications, infectious complications or wound healing complications were reported. All patients showed satisfactory results, and reported high cosmetic and functional satisfaction with the appearance of their reconstructed breasts and axillary comfort. Conclusions In the authors' experience, the lateral capsular flap represents a simple, safe and reliable technique to correct breast implant lateral malposition, reconstruct the lateral breast border, and address unwanted axillary fullness in primary or revision implant-based breast reconstruction with improved cosmetic appearance and balance of the breast.
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Affiliation(s)
- Brent R Degeorge
- Department of Plastic and Maxillofacial Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Christopher A Campbell
- Department of Plastic and Maxillofacial Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
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Lemaine V, Hoskin TL, Farley DR, Grant CS, Boughey JC, Torstenson TA, Jacobson SR, Jakub JW, Degnim AC. Introducing the SKIN score: a validated scoring system to assess severity of mastectomy skin flap necrosis. Ann Surg Oncol 2015; 22:2925-32. [PMID: 25634782 DOI: 10.1245/s10434-015-4409-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND With increasing use of immediate breast reconstruction (IBR), mastectomy skin flap necrosis (MSFN) is a clinical problem that deserves further study. We propose a validated scoring system to discriminate MSFN severity and standardize its assessment. METHODS Women who underwent skin-sparing (SSM) or nipple-sparing mastectomy (NSM) and IBR from November 2009 to October 2010 were studied retrospectively. A workgroup of breast and plastic surgeons scored postoperative photographs using the skin ischemia necrosis (SKIN) score to assess depth and surface area of MSFN. We evaluated correlation of the SKIN score with reoperation for MSFN and its reproducibility in an external sample of surgeons. RESULTS We identified 106 subjects (175 operated breasts: 103 SSM, 72 NSM) who had ≥1 postoperative photograph within 60 days. SKIN scores correlated strongly with need for reoperation for MSFN, with an AUC of 0.96 for SSM and 0.89 for NSM. External scores agreed well with the gold standard scores for the breast mound photographs with weighted kappa values of 0.82 (depth), 0.56 (surface area), and 0.79 (composite score). The agreement was similar for the nipple-areolar complex photographs: 0.75 (depth), 0.63 (surface area), and 0.79 (composite score). CONCLUSIONS A simple scoring system to assess the severity of MSFN is proposed, incorporating both depth and surface area of MSFN. The SKIN score correlates strongly with the need for reoperation to manage MSFN and is reproducible among breast and plastic surgeons.
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Affiliation(s)
- Valerie Lemaine
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA,
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Persichetti P, Segreto F, Pendolino AL, Del Buono R, Marangi GF. Breast implant capsule flaps and grafts: a review of the literature. Aesthetic Plast Surg 2014; 38:540-8. [PMID: 24764105 DOI: 10.1007/s00266-014-0308-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/18/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND A breast implant capsule forms as a physiological response to the foreign material. Over the past decades, authors started to consider the breast implant capsule as a new source of tissue, thus describing several capsular flaps and grafts. The aim of this article is to provide an overview of the applications and indications for the use of capsular tissue flaps and grafts in reconstructive and aesthetic surgery. METHODS A review of the literature on breast implant capsule grafts and flaps was conducted. The reported surgical techniques were described and compared for indications and complications. The studies were evaluated and compared for number of patients and follow-up. RESULTS The search yielded a total of 21 citations. Patient population was reported in 11 studies for capsular flaps and 2 articles for capsular grafts. Between 1997 and 2012, a total of 74 patients underwent surgery with the use of capsular tissue. Among these, 60 patients had a capsular flap (81 %) and 14 (19 %) had a capsular graft. Complications were experienced in 5 patients (6.7 %). CONCLUSIONS Capsular flaps and grafts are indicated mainly to address breast implant-related problems. The breast implant capsule represents a versatile and reliable source of tissue for both aesthetic and reconstructive surgery. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
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Affiliation(s)
- Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, 00128, Rome, Italy
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Mayer HF, Loustau HD. Capsular grafts and flaps in immediate prosthetic breast reconstruction. Aesthetic Plast Surg 2014; 38:129-138. [PMID: 24337173 DOI: 10.1007/s00266-013-0249-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/13/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with previously augmented breasts and a diagnosis of breast cancer who are candidates for immediate prosthetic reconstruction can benefit from capsular tissues used for splinting the position of the pectoralis major muscle. METHODS A retrospective clinical review of patients with previously augmented breasts who are undergoing mastectomy and immediate prosthetic reconstruction with capsular tissues was undertaken. The bottom of the periprosthetic capsule was tailored in a novel and versatile fashion as grafts or flaps and used as a sling between the pectoralis major and the inframammary fold. RESULTS Of the 21 patients in this study, 19 had unilateral reconstruction, whereas 2 had bilateral reconstructions. Capsular tissues were harvested as free capsular grafts in 15 cases and raised as a capsular flap in the remaining 8 cases. During the follow-up period, complications were detected in 7 patients (1 seroma, 1 infection, 1 hematoma, 1 superficial epidermolysis, 2 cases of rippling, and 1 mild capsular contracture). CONCLUSIONS For eligible patients, the use of capsular tissues offers a readily available and cost-effective alternative to acellular dermal matrices with a negligible complication rate. Patient selection is key to ensuring a safe oncologic approach and must be carefully carried out in close collaboration with the breast surgeon. 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 .
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Affiliation(s)
- Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Perón 4190, 1st Floor (1181), Buenos Aires, Argentina.
| | - Hugo D Loustau
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Perón 4190, 1st Floor (1181), Buenos Aires, Argentina
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Bogdanov-Berezovsky A, Silberstein E, Shoham Y, Krieger Y. Capsular flap: new applications. Aesthetic Plast Surg 2013; 37:395-7. [PMID: 23435509 DOI: 10.1007/s00266-013-0094-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/31/2013] [Indexed: 11/28/2022]
Abstract
UNLABELLED Breast augmentation with silicone implants is one of the most commonly performed procedures for women seeking improvement in their body image. Because the number of breast augmentation operations is growing, the number of subsequent reoperations is increasing. Causes for repeated operative procedures include infection, capsular contracture, silicone implant replacement, and breast reaugmentation. As the average volume of silicone implants used is steadily growing according to patients' wishes and fashion requirements, the plastic surgeon often is asked to replace the silicone implants with larger implants. Replacing breast implants with a similar sized implant is a relatively simple operation, but insertion of larger implants may present a challenge due to insufficient soft tissue coverage of the lower pole of the larger breast implant, especially in thin subjects. Total coverage of the breast implant can be achieved by use of tissue substitutes (TS), such as acellular dermal matrices. Usage of TS, however, is prone to complications and very costly, and these factors influence the implementation of TS in a private practice setup. This report describes a capsular flap used to cover the lower pole of breast implants. The flap guarantees multilayered stable wound closure and prevents displacement of the inframammary fold. The capsular flap also was used to correct an inferiorly displaced inframammary fold as a consequence of the breast augmentation. LEVEL OF EVIDENCE V 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 .
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Affiliation(s)
- A Bogdanov-Berezovsky
- Department of Plastic and Reconstructive Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101, Beer-Sheva, Israel.
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Acellular Dermal Matrix for the Treatment and Prevention of Implant-Associated Breast Deformities. Plast Reconstr Surg 2011; 127:1047-1058. [DOI: 10.1097/prs.0b013e31820436af] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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