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Knoedler S, Knoedler L, Kauke-Navarro M, Alfertshofer M, Obed D, Broer N, Kim BS, Könneker S, Panayi AC, Hundeshagen G, Kneser U, Pomahac B, Haug V. Quality of life and satisfaction after breast augmentation: A systematic review and meta-analysis of Breast-Q patient-reported outcomes. J Plast Reconstr Aesthet Surg 2024; 95:300-318. [PMID: 38945110 DOI: 10.1016/j.bjps.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Breast augmentation ranks among the most popular plastic surgery procedures. Yet, reports on post-operative patient-reported quality of life (QoL) and satisfaction remain conflicting. METHODS A systematic review was conducted following the PRISMA guidelines. Three databases were searched for eligible studies that reported pre-and/or post-operative Breast-Q™ augmentation scores for patient QoL (psychosocial, sexual, and physical well-being) and/or satisfaction. RESULTS A total of 39 studies (53 patient cohorts and 18,322 patients) were included in the quantitative synthesis. The pairwise meta-analysis revealed significant improvements in patient-reported psychosocial (MD: +38.10) and sexual well-being (MD: +40.20) as well as satisfaction with breast (MD: +47.88) (all p < 0.00001). Physical well-being improved slightly after breast augmentation (MD: +6.97; p = 0.42). The single-arm meta-analysis yielded comparable results, with Breast-Q™ scores in psychosocial and sexual well-being as well as satisfaction with breast increasing from 37.2, 31.1, and 26.3 to 75.0, 70.6, and 72.7, respectively (all p < 0.00001). Physical well-being improved by 8.1 (75.8 pre-operatively to 83.9 post-operatively; p = 0.17). Subgroup analyses highlighted higher QoL and satisfaction following breast augmentation for purely esthetic purposes and alloplastic mammaplasty. Although patient-reported physical and sexual well-being increased in the long term, psychosocial well-being was the highest in the short term. CONCLUSION Patient satisfaction with breast, psychosocial, and sexual well-being increased significantly after breast augmentation. In contrast, patient-reported physical well-being yielded ambivalent results, varying by mammaplasty technique and post-operative follow-up time. Plastic surgeons should be sensitized about our findings to refine eligibility criteria and gain a deeper understanding of the patients' perceived surgical experience. PROSPERO TRIAL REGISTRATION NO CRD42023409605.
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Affiliation(s)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leonard Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Michael Alfertshofer
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Munich, Munich, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Sören Könneker
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
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Rosenthal A, Goldbart Nahmias A, Heller L, Hadad E. Silicone Lymphadenopathy Following Augmentation Mammoplasty With Silicone Implants. Aesthet Surg J 2024:sjae113. [PMID: 38762900 DOI: 10.1093/asj/sjae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Silicone implants claim the predominant share in global implant usage for breast augmentation. Despite technological advancements, complications persist, with silicone lymphadenopathy (siliconoma) being a noteworthy concern. This phenomenon has been inadequately addressed in the existing literature. OBJECTIVES To characterize axillary siliconomas and identify potential risk factors to help reduce their occurrence. METHODS The authors conducted a retrospective observational cross-sectional study spanning between 2011 to 2021 at the Shamir-Assaf Harofeh Medical Center. Preoperative ultrasound examination was conducted, categorizing patients into those with siliconomas and those without. RESULTS A total of 614 women (1209 breasts) met the inclusion criteria. The incidence of siliconomas was 13.6% (165 breasts). In univariate analysis, older age (age 47 years vs. 43 years, P < 0.001), older implant age (12.2 vs. 11 years, P = 0.026), ruptured implants (59.4% vs 17.7%, P < 0.001), subpectoral placement (P = 0.019), severe capsular contracture, and the use of Mentor implants (Irvine, CA; P = 0.007) and Poly Implant Prothèse implants (PIP; La Seyne-sur-Mer, France; P = 0.001) correlated significantly with the presence of siliconomas. In a multivariate analysis, implant rupture (OR = 6.342), and implant manufacturer - Mentor (OR = 3.047) and PIP (OR = 3.475), were identified as independent risk factors associated with a higher incidence of siliconomas. Severe capsular contracture was associated with higher incidence of siliconomas as well (OR = 1.65). CONCLUSIONS Surgeons should inform candidates about the potential risk of silicone migration. Patients with ruptured implants, significant capsular contracture, Mentor and PIP implants face an increased risk for developing siliconomas. Closer monitoring for the detection of siliconomas in the axilla for these patients is advisable, potential prophylactic replacement or removal of implants may be warranted to mitigate siliconoma risk.
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Affiliation(s)
- Adaya Rosenthal
- Department of Plastic Surgery, Shamir Medical Center, Zerifin, Israel
| | | | - Lior Heller
- Department of Plastic Surgery, Shamir Medical Center, Zerifin, Israel
| | - Eran Hadad
- Department of Plastic Surgery, Shamir Medical Center, Zerifin, Israel
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3
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de Faria Castro Fleury E. Breast silicone implants' pericapsular impairment: current underdiagnosed status. Front Surg 2023; 10:1249078. [PMID: 37780912 PMCID: PMC10536283 DOI: 10.3389/fsurg.2023.1249078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Many complications related to silicone implants have been reported recently, from clinical symptoms manifestations to association with some specific types of cancer. During the early 2010s, it was believed that implants were biocompatible and inert to the human body and that gel bleeding/leakage events were rare and without repercussions for the human body. However, at the end of 2010s, several studies pointed out that gel bleeding was more frequent than previously believed, and the pathogenic potential of free silicone should not be ignored. The Food and Drug Administration recommends performing magnetic resonance imaging in asymptomatic patients 5-6 years after implant placement. The descriptors in the Breast Imaging and Reporting Data System lexicon seem outdated for classifying the new generations of implants with cohesive gel, which hinders the diagnosis of device complications. In this review, supported by our research data publications related to silicone implants for 6 years on a prospective study protocol, most of them being original articles, we summarized the main complications observed in clinical practice and discuss the impact of these changes on patients' outcomes focusing on the pericapsular space.
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Affiliation(s)
- Eduardo de Faria Castro Fleury
- Department of Radiology, Centro Universitário São Camilo—Curso de Medicina, São Paulo, Brazil
- IBCC Oncologia, São Paulo, Brazil
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Zucal I, Tremp M, Duscher D, Wenny R, Zaussinger M, Kutz A, Pagani A, Huemer GM. Augmentation-Mastopexy: Analysis of 95 Consecutive Patients and Critical Appraisal of the Procedure. J Clin Med 2023; 12:jcm12093213. [PMID: 37176652 PMCID: PMC10179061 DOI: 10.3390/jcm12093213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Single-stage mastopexy-augmentation has been demonstrated to be a safe procedure. However, revisions may still be necessary. We evaluate 95 consecutive patients undergoing mastopexy-augmentation and introduce a new surgical technique for the procedure: the modified dual plane technique. In this retrospective study, 95 patients (mean age 34 ± 11 years) underwent mastopexy-augmentation between 2009 and 2019. The procedures were classified as subglandular, dual plane, or modified dual plane technique. The outcome measures included major and minor complications. A total of 19 patients underwent a subglandular procedure, 32 patients a dual plane procedure, and 44 patients a modified dual plane procedure. We observed a high overall complication rate in the subglandular group (n = 12, 63%), dual plane group (n = 15, 47%), and modified dual plane group (n = 10, 23%). Complications leading to implant loss/change occurred in seven patients in the subglandular group (37%), six patients in the dual plane group (19%), and no patient in the modified dual plane group. While we observed a high complication rate in patients undergoing mastopexy-augmentations, the modified dual plane technique was associated with a lower complication rate.
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Affiliation(s)
- Isabel Zucal
- Department of General Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Mathias Tremp
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Dominik Duscher
- TF Plastic Surgery and Longevity Center, Herzogstrasse 67, 80803 Munich, Germany
- TF Plastic Surgery and Longevity Center, Dorotheergasse 12, 1010 Vienna, Austria
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Raphael Wenny
- Section of Plastic, Aesthetic and Reconstructive Surgery, Medcampus III, Kepler University Hospital, 4020 Linz, Austria
| | - Maximilian Zaussinger
- Section of Plastic, Aesthetic and Reconstructive Surgery, Medcampus III, Kepler University Hospital, 4020 Linz, Austria
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine Cantonal Hospital Aarau, 5001 Aarau, Switzerland
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Andrea Pagani
- Department of Orthopedics, Traumatology and Hand Surgery, Hospital of Bolzano-SABES, 39100 Bolzano, Italy
| | - Georg M Huemer
- Section of Plastic, Aesthetic and Reconstructive Surgery, Medcampus III, Kepler University Hospital, 4020 Linz, Austria
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Paolini G, Firmani G, Briganti F, Macino M, Nigrelli S, Sorotos M, Santanelli di Pompeo F. Assessment of Risk Factors for Rupture in Breast Reconstruction Patients with Macrotextured Breast Implants. Aesthetic Plast Surg 2023; 47:517-530. [PMID: 36229658 PMCID: PMC10070228 DOI: 10.1007/s00266-022-03118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/11/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Breast implants (BI) are widely used in plastic surgery, though they are not lifetime devices. Average life before rupture is reported to be around 10-15 years. No consensus exists regarding which factors are involved. OBJECTIVES Following FDA recommendations, this study aims at identifying potential risk factors by evaluating their effect on BI rupture cases. METHODS In this observational study, 763 BI patients were operated between 2003 and 2019, with a mean implant indwelling of 12.2 years. Patients that returned for follow-up were administered a questionnaire regarding postoperative lifestyle and habits. Implant rupture rate was 15.1%, while BI lifespan was 10.1 years. We obtained complete data from 191 breast implant patients (288 implants). Twenty-three potential risk factors were evaluated and divided in four categories: patient-related, surgery-related, postoperative complications/symptoms, and postoperative care/lifestyle habits. Odds Ratio (OR) for each factor was calculated. Linear regression analysis was calculated for those with a significant OR. RESULTS We report 120 patients (195 implants) with intact and 71 (93 implants) with ruptured devices. BIs were macrotextured in 95.1% of cases (86.8% Allergan BIOCELL). OR was significant for underwire bra use (OR: 2.708), car seat belts (OR: 3.066), mammographic imaging (OR: 2.196), weightlifting (OR: 0.407) and carry-on heavy purses and backpacks (OR: 0.347). CONCLUSION Wearing underwire bras, seat belts and undergoing mammography increases the risk of rupture. Weightlifting and carry heavy bags do not increase that risk. Implant rupture is directly linked with time of indwelling. Postoperative recommendations in BI patients should consider findings from our study, though larger multicenter studies should be encouraged. 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)
- Guido Paolini
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Faculty of Medicine and Psychology, Azienda Ospedaliera Sant'Andrea - U.O.D. Chirurgia Plastica, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Francesca Briganti
- Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Mattia Macino
- Department of Biomedicine and Prevention, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Simone Nigrelli
- Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Michail Sorotos
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Faculty of Medicine and Psychology, Azienda Ospedaliera Sant'Andrea - U.O.D. Chirurgia Plastica, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Fabio Santanelli di Pompeo
- NESMOS Department, Faculty of Medicine and Psychology, Chair of Plastic Surgery - Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
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6
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Silicone Breast Implant Rupture is More Prevalent in the Dominant Limb Side, A Retrospective Cohort Study. J Plast Reconstr Aesthet Surg 2023; 80:126-132. [PMID: 37011442 DOI: 10.1016/j.bjps.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Breast implant rupture is associated with multiple risk factors such as implant age, manufacturer, and a history of trauma to the breast. However, the exact mechanism of breast implant rupture remains unclear. We hypothesize that repetitive minor mechanical forces on the implant collectively play a significant role in the cascade that eventually leads to its rupture. Therefore, we expect a more significant cumulative effect on the breast implant in the dominant upper limb side. Thus, we aim to ascertain whether laterality in silicone breast implant rupture is associated with the dominant upper limb. METHODS A retrospective cohort study was performed on patients with silicone breast implants who underwent an elective breast implant removal or exchange. All patients had breast augmentations for cosmetic reasons. We collected data on implant rupture laterality and limb dominance together with known risk factors like patient age, implant age, implant pocket, and implant volume. RESULTS A total of 154 patients with unilateral implant rupture were included in the study. Among patients with a dominant right limb (n = 133), an ipsilateral rupture was found in 77 patients (58%) (p = 0.036), while in patients with a left dominant limb (n = 21), an ipsilateral rupture was found in 14 patients (67%), (p = 0.036). CONCLUSIONS The dominant limb was a significant risk factor for ipsilateral breast implant rupture. The prevailing theory that cyclic envelope movement carries an increased rupture risk is reinforced in this study. Extensive prospective studies are needed to clarify risk factors for implant rupture further.
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7
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ORS S. Evaluation of different breast implants for rupture and durability after implantation. TURKISH JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.4103/tjps.tjps_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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8
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A Surgeon's Empirical Perspectives on Use of High-resolution Ultrasound in Preoperatively Detecting a Rupture in the Context of Breast Implant Crisis in Korea. Aesthetic Plast Surg 2022; 46:1668-1678. [PMID: 35296929 DOI: 10.1007/s00266-022-02844-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND We previously proposed a novel method for detecting a rupture of a breast implant using high-resolution ultrasound (HRUS). We therefore conducted this retrospective, observational study to describe its feasibility in making a preoperative diagnosis of rupture of the device in patients receiving an implant-based augmentation mammaplasty. METHODS We initially evaluated the medical records of the patients who had received primary or secondary augmentation mammaplasty using a breast implant at other hospitals for aesthetic or reconstructive purposes between August 31, 2017, and August 31, 2020. The patients underwent breast US using the Aplio i600 (Canon Medical System, Otawara, Tochigi, Japan) system with a 7-18 MHz linear transducer. Through a retrospective review of the patients' medical records, we analyzed their baseline and clinical characteristics. Then, we compared an agreement between preoperative diagnosis of rupture on HRUS and findings at reoperation. RESULTS A total of 29 patients with rupture (55 breasts) were evaluated for the performance of ultrasound in making a diagnosis of rupture. This showed that they were unaware of rupture but they were diagnosed with it on ultrasound. Preoperatively, there were no cases of rupture in 110 left breasts (80.9%) and 107 right breasts (78.7%), which exactly matched to the number of breasts without rupture on HRUS. Moreover, preoperatively, there were 26 (19.1%) and 29 cases (21.3%) of rupture in the left and right breast, respectively, which exactly matched to the number of breasts with rupture on HRUS. CONCLUSIONS In conclusion, patients who are suspected of having rupture of a breast implant should be stringently evaluated for presence of rupture and, if any, its scope using HRUS. Moreover, we propose that surgeons consider using HRUS in making a preoperative diagnosis of rupture of a breast implant. LEVEL OF EVIDENCE III 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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Shepard E, Kamenko S, Snir OL, Hansen J. Silicone granuloma mimicking Breast Implant Associated Large Cell Lymphoma (BIA-ALCL): a case report. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2020; 7:63-67. [PMID: 32596416 PMCID: PMC7301711 DOI: 10.1080/23320885.2020.1762495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/27/2020] [Indexed: 12/17/2022]
Abstract
We describe the case of a 75-year-old woman with textured silicone implants who was referred to our institution with concern for implant rupture and Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). After explantation and pathologic evaluation, she was diagnosed with silicone granuloma and adenitis, though her presentation mimicked BIA-ALCL.
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Affiliation(s)
| | - Srdjan Kamenko
- Division of Plastic and Reconstructive Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Olivia L Snir
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Juliana Hansen
- Division of Plastic and Reconstructive Surgery, Oregon Health and Sciences University, Portland, OR, USA
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10
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Abstract
This review discusses the historical development of smooth and textured silicone gel filled implants, and examines the reasoning behind product development and aspects of surgical technique from a surgeon's perspective.
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Affiliation(s)
- D Perry
- Anglia Ruskin University, Chelmsford, UK
| | - J D Frame
- Anglia Ruskin University, Chelmsford, UK
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11
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Shen Z, Chen X, Sun J, Chiu C, Yu Y, Lin X, Zhang Z, Xu J. A comparative assessment of three planes of implant placement in breast augmentation: A Bayesian analysis. J Plast Reconstr Aesthet Surg 2019; 72:1986-1995. [PMID: 31653596 DOI: 10.1016/j.bjps.2019.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/05/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Techniques based on three planes of implant placement, including the subglandular (SG), subpectoral (SP), and subfascial (SF) planes are used for breast augmentation. The placement that offers the greatest balance of risks and benefits is unclear. This study presents a systematic review with a Bayesian network meta-analysis to compare different implant placement techniques for augmentation mammaplasty. METHODS A systematic literature search was performed. We estimated the odds ratios (ORs) for capsular contractures, hematomas, seromas, infections, reoperation rates, rippling, nipple numbness, malplacements, ruptures, and asymmetry among the different interventions. Muscle movement events and satisfaction rates were also evaluated. RESULTS A total of 19 studies (25,744 cases) were included. SG placement significantly increased the incidence of capsular contractures (SP vs. SG: OR 0.42; 95% credible interval [CrI] 0.28-0.63; SF vs. SG: OR 0.41; 95% CrI 0.17-0.97), hematomas (SF vs. SG: OR 0.22; 95% CrI 0.06-0.63), and seromas (SF vs. SG: OR 0.04; 95% CrI 0.00-0.81) compared to other placement techniques. Muscle movement only occurred in the SP group, but it did not increase the risk of subsequent malplacements, asymmetries, or ruptures. Most patients were highly satisfied with their surgical results. Comparisons did not show significant differences in the remaining results. CONCLUSIONS Our evidence suggests that SG placement increases the risk of capsular contractures, hematomas, and seromas. The SP and SF planes were safe and effective for controlling total complication rates and achieving high satisfaction rates; however, the long-term benefits of the SF technique require further research.
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Affiliation(s)
- Zeren Shen
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Xi Chen
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Jiaqi Sun
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Chiaoyun Chiu
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Yijia Yu
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Xiaohu Lin
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Zhe Zhang
- Economic Operation Monitoring Center, Zhejiang Institute of Industry and Information Technology, No. 79 Qingchun Road, Hangzhou 310003, China
| | - Jinghong Xu
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, China.
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