Lightweight breast implants: a novel solution for breast augmentation and reconstruction mammaplasty

Quality of life in breast reconstruction: a comparison of lightweight and conventional breast implants

BACKGROUND

Due to the declining mortality rates of breast carcinoma and the rising incidence of risk-reducing mastectomies, enhancing the quality of life after breast reconstructions has become an increasingly important goal. The advantages of lightweight breast implants (B-Lite®) may significantly contribute to achieving this objective. This study aims to investigate whether lightweight implants are suitable for patients undergoing breast reconstruction and could improve the quality of life in comparison to conventional implants.

METHODS

In this study, we retrospectively analyzed 48 patients (38 implants in each group) who underwent implant-based breast reconstruction with either B-Lite® or conventional breast implants between 2019 and 2022 at the University Center for Plastic Surgery in Regensburg. As part of the postoperative follow-up, a clinical examination and a survey using the Breast-Q® questionnaire were conducted to evaluate the postoperative quality of life.

RESULTS

The implants used were similar in weight and shape. On average, the B-Lite® implants had a higher implant volume and patients in this group had a slightly higher BMI. Patients who received B-Lite® implants showed a significantly better result regarding the sensation of sensitivity in the surgical area and the scar formation also appeared to be more favorable. However, patients with B-Lite® implants perceived their implants as more uncomfortable than those with conventional breast implants. In other terms concerning quality of life, both groups appeared similar.

CONCLUSION

In summary, there are confounding factors that could influence the outcome of some aspects in this study, which could not be avoided due to the retrospective study design and the temporary suspension of B-Lite implants. Nevertheless, as the first of its kind, this study demonstrated that B-Lite implants could also be suitable for usage in breast reconstructions, thus providing an important foundation for further prospective studies to build upon.

Nonadherence of Polyurethane Implants: A Retrospective Cohort Study

Background  Biointegration of polyurethane (PU) implants providing their stable position years after surgery ensures predictable results of breast augmentation and reconstruction almost eliminating implant factor as a cause of complications. However, in rare cases PU implants appear to be not connected to the surrounding tissues. The aim of the study was to determine the incidence of PU implant nonadherence after primary breast augmentations and augmentation mastopexies with dual plane implant position, to analyze possible causes, and to propose preventive measures and treatment possibilities of this complication. Methods  The results of primary aesthetic surgeries in 333 patients with dual plane PU implant placement were analyzed. Patients were evaluated clinically, and pictures and videos taken in different periods after the surgery were compared. Particular attention was given to the changes in implant position and the appearance of asymmetries over time. Results  PU implant nonadherence was found in seven patients. It can be divided into primary and secondary and may be complete or partial. Primary nonadherence was found in two cases (0.6%), and secondary in five (1.5%) cases. Possible influencing factors could have been traumatic surgical technique, seroma, hematoma, or physical trauma. The average follow-up was 33 months (1 month-15 years). Conclusion  Biointegration is mandatory for the long-term predictable results with PU implants. PU implant nonadherence leads to implant malposition and may cause typical complications connected to non-PU implants. Improvements in surgical maneuvers, manufacturing process, and weight reduction of the implant may be beneficial for the stability of the results. Level of Evidence  V.

Kite Mastopexy: Small Scar and Tissue-conserving Technique

Background

Breasts are considered one of the most physically and sexually appealing features of the female body. Reduction/augmentation techniques have greatly evolved in the last decades.We are reporting our experience with an innovative technique for mastopexy that recovers the aesthetics of the breast and avoids over-resection of its lower pole.

Methods

Inclusion criteria were women who underwent kite mastopexy with or without implants between January 2018 and May 2022 in a single center (Bogota, Colombia). Exclusion criteria were patients with American Society of Anesthesiology score more than II, with any uncontrolled chronic illness and/or medical history of diabetic mellitus, metabolic syndrome, body mass index more than 32 kg per m2, and active smokers.

Results

We found 133 consecutive female patients. Age range was 18 and 67 years (median 39). Breast implants were used for the purpose of kite mastopexy in 52% cases. Patients were divided into two groups: implants (group 1) versus no implants (group 2). Procedure 1 involved mastopexy without implants; procedure 2 included current implant users who underwent either implant removal or in whom implants were not used for the sake of mastopexy. Procedures 3 and 4 included patients who underwent either new implant placement or implant exchange, respectively. Average time of surgery was 1.5 hours. Minor complications were mostly related to wound dehiscence. No major complications were reported.

Conclusions

Kite mastopexy restores the breast aesthetics by following specific markings, a new plication of breast pillars, and a reduced scar. Our technique demonstrates a very low rate of complications while entailing natural and appealing results.

Lightweight implants in breast reconstruction

OBJECTIVE

Since the first use of silicone implants by Cronin in 1962, there have been several attempts to introduce alternative filling materials for breast implants on the market. A promising new development are lightweight implants, whose filler material is one third lighter than conventional silicone gel. While these implants have been used primarily for aesthetic augmentation, a benefit could be expected particularly in post-mastectomy reconstruction.

MATERIALS AND METHODS

Since 2019, 92 operations using lightweight implants have been performed at our clinic, 61 of them for breast reconstruction after mastectomy. These have been compared to 92 breast reconstructions using conventional silicone implants.

RESULTS

The average volume of the lightweight implants was 30% higher than of the conventional implants (452 ml resp. 347 ml), whereas the implant weight was comparable in both groups (317 g resp. 347 g). Grade 3-4 capsular fibrosis was seen in 6 cases in both groups; revision was required 9 times (lightweight implants) and 7 times (conventional silicone implants) during the follow-up period.

DISCUSSION

To our knowledge, this is the first study to investigate the use of lightweight implants in breast reconstruction. With exception of the filler material, the implants used in the two groups were comparable in shape and surface. The inserted lightweight implants had a greater volume but nearly the same weight as the conventional implants and were used in patients with a higher body mass index. Thus, lightweight implants were preferred in patients whose reconstruction required a larger implant volume.

CONCLUSION

Lightweight implants are a new alternative for breast reconstruction especially in case that larger implant volume is demanded. The increased complication rate has to be verified in further studies.

[Renaissance of prepectoral implant-based breast reconstruction: theoretical basis and research status]

Objective

To overview the theoretical basis and research status of prepectoral implant-based breast reconstruction.

Methods

The domestic and foreign researches on the application of prepectoral implant-based breast reconstruction in breast reconstruction were retrospectively analyzed. The theoretical basis, clinical advantages, and limitations of this technique were summarized and the future development trend in this field was discussed.

Results

The recent advances in breast cancer oncology, the development of materials and the concept of oncology reconstruction have provided a theoretical basis for prepectoral implant-based breast reconstruction. The selection of patients and the experience of surgeons are crucial for postoperative outcomes. Ideal thickness and blood flow of flaps are the most important considerations for the selection of prepectoral implant-based breast reconstruction. However, its long-term reconstruction outcomes and clinical benefits and risks in Asian populations still need to be confirmed by more studies.

Conclusion

Prepectoral implant-based breast reconstruction has a broad application prospect in breast reconstruction following mastectomy. However, the evidence is limited at present. Randomized study with long-term follow-up is urgently in need to provide sufficient evidence to evaluate the safety and reliability of prepectoral implant-based breast reconstruction.

Effects of Artificially Induced Breast Augmentation on the Electromyographic Activity of Neck and Trunk Muscles during Common Daily Movements

A female breast can be a potential source of musculoskeletal problems, especially if it is disproportionately large. The purpose of the present study was to examine the effect of artificially induced breast volume on the EMG activity of neck and trunk musculature during common everyday movements. The EMG activity of the sternocleidomastoid (SCM), the upper trapezius (UT), and the thoracic and lumbar erector spinae (TES, LES) were recorded during 45° trunk inclination from the upright standing and sitting postures (TIST45°, TISI45°) as well as during stand-to-sit and sit-to-stand (STSI, SIST) in 24 healthy females with minimal and ideal breast volume (M-NBV, I-NBV). All movements were performed before and after increasing M-NBV and I-NBV by 1.5-, 3.0-, 4.5-, and 6-times using silicone-gel implants. Significantly higher EMG activity for TES and LES were found at 6.0- and ≥4.5-times increase the I-NBV, respectively, compared to smaller breast volumes during TIST45°. EMG activity of UT was higher, and TES was lower in M-NBV females compared to I-NBV females in all movements but were significantly different only during SIST. The female breast can affect the activity of neck and trunk muscles only when its volume increases above a certain limit, potentially contributing to muscle dysfunction.

[The Value of Synthetic and Biologic Meshes in Implant-Based Breast Reconstruction]

Implant based breast reconstruction (IBBR) keeps evolving and has been influenced heavily by the use of synthetic and biologic meshes in the last years. In both, subpectoral as well as prepectoral approaches the use of synthetic and biologic meshes has made it possible to place implants precisely according to the breast's footprint and strengthen soft-tissue coverage, particularly in the lower pole of the breast with lower complication rates and better cosmesis. Various mesh options that differ in material, processing, size and cost are currently in clinical use. This review aims to define the role of biologic and synthetic meshes in IBBR regarding the advantages and disadvantages of their use.

The History of Plastic Surgery in Israel

Today, plastic surgery is a well-known profession with highly respected surgeons from institutions all over the world. Over the last several decades numerous clinical and technological advances have been made, thanks to the dedication and hard work of these outstanding professionals; however, things were not always this way. At the turn of the 20th century, Israel had yet to be introduced to the field of plastic surgery. However, this all changed with the War of Independence. Humanitarian aid by the prominent South African surgeon, Jack Penn, laid the foundation for the founding fathers of plastic surgery in Israel to establish a strong legacy of producing world-renowned surgeons and innovators. Through this paper, we hope to provide a brief overview of the history of plastic surgery in Israel and what transpired to give us the state of surgical practice we have today.

Implant-Based Breast Reconstruction after Mastectomy, from the Subpectoral to the Prepectoral Approach: An Evidence-Based Change of Mind?

Over the last years, prepectoral implant-based breast reconstruction has undergone a renaissance due to several technical advancements regarding mastectomy techniques and surgical approaches for the placement and soft tissue coverage of silicone implants. Initially abandoned due to the high incidence of complications, such as capsular contraction, implant extrusion, and poor aesthetic outcome, the effective prevention of these types of complications led to the prepectoral technique coming back in style for the ease of implant placement and the conservation of the pectoralis muscle function. Additional advantages such as a decrease of postoperative pain, animation deformity, and operative time contribute to the steady gain in popularity. This review aims to summarize the factors influencing the trend towards prepectoral implant-based breast reconstruction and to discuss the challenges and prospects related to this operative approach.

Israeli Innovations in the Field of Plastic Surgery

Numerous innovations within the field of plastic surgery have been developed in Israel over the last few decades. Many of these therapeutic devices and techniques have been established globally with demonstrable efficacy and respectable safety profiles. This article offers an overview of recent Israeli cutting-edge medical therapeutic solutions contributing to the global practice of plastic surgery.

Five-Year Safety and Satisfaction With the Lightweight Breast Implant

Background

The B-Lite lightweight breast implant (LWBI) weighs approximately 30% less than traditional silicone implants while maintaining an equivalent size, form, and function. The LWBI thus places less stress on breast tissues and preserves tissue stability and integrity over time, reducing weight-related complications and reoperation rates.

Objectives

The authors sought to assess the long-term (>5 years) safety and performance of the LWBI in primary and revision augmentation procedures.

Methods

A retrospective, single-center, single surgeon analysis of prospectively collected data was performed on 827 consecutive primary and revision augmentation patients operated between December 2013 and January 2019. A total 1653 implants (250-835 cc, mostly round, textured, extra high-profile) were implanted employing standard surgical techniques. Direct physician-to-patient follow-up ranged from 6 to 67 months. Chart data on reoperations and overall complications as well as patient and surgeon satisfaction were analyzed.

Results

The 5-year per patient Kaplan–Meier reoperation free rate was very high (97.1%). Only 2 of 5 total cases of capsular contracture (CC) grade III required reoperation (Kaplan–Meier rate = 0.2%, CI = 0.1–1.0). No cases of rupture or breast implant-associated anaplastic large cell lymphoma were recorded. A total 94.9% of patients rated the aesthetic outcome, and 95.5% of patients rated the natural look and feel of their breasts at 4 to 5 (satisfied-very satisfied). Similarly, the surgeon rated 4 to 5 on 95.4% of the patients’ aesthetic outcomes.

Conclusions

The favorable safety profile, high patient and surgeon satisfaction, and inherent benefits of reduced weight should make the LWBI a strongly considered strategic alternative to traditional implants.

Level of Evidence: 3

Optimizing Surgical Outcomes with Small-Volume Silicone Implants Associated with Autogenous Fat Grafting in Primary and Revision Breast Augmentation Surgery: Soft Weight Hybrid (SWEH) Concept

BACKGROUND

Simultaneous association of autologous fat grafting (AFG) with silicone implants, defined as a hybrid procedure, has been proposed for breast augmentation (BA). In some patients, larger-volume implants may result in larger incisions, with long-term effects including implant palpability, soft tissue atrophy, and secondary ptosis. Some patients do not want large volume implants, or have insufficient soft tissue coverage. Recent improvements in AFG have led to new surgical options in BA for addressing these cases.

OBJECTIVES

This study combines AFG in BA using small-volume implants, known as the SWEH (soft weight hybrid) approach, and evaluates aesthetic advantages and outcomes following primary/secondary BA.

METHODS

25 patients (50 breasts) underwent SWEH procedures; this approach was indicated when the overlying tissue was insufficient to adequately cover the implant and patients refused large-volume implants. Three-dimensional images were obtained using a Divina 3D scanner system (AX3 Technologies, Miami, USA) to assess breast volume (BV) and intermammary distance (IMD) during follow-up.

RESULTS

Mean patient age was 29.3 years (range: 21-42) and mean body mass index was 19.3 kg/m² (15.3-27.2). The most common implant (SmoothSilk surface Round/Ergonomix style) volume was 180 cc (175-215), and patients received a mean volume of 125 cc of fat (89-168)/breast in the subcutaneous tissue. Preoperative average BV measurements were 236.85 cc (170-335). At 3 and 12 months post-procedure, the average BV values were 488.82 and 478.73cc, respectively (p=0.475). The average preoperative IMD was 31.76 mm (range, 22-43); at 3 and 12 months post-procedure, the average IMD was 20.47 and 20.94 mm, respectively (p=0.61). Postoperative complications included subcutaneous banding in the axilla (n = 1; 4%) and hypertrophic scarring (n = 1; 4%). Breast imaging exams were performed; in 2 breasts (8%) localized oil cysts were observed; no cases of suspicious calcifications, fat necrosis, or lumps were seen. Fat retention rate (1 year) was calculated by the difference between the BV expected with 100% fat intake and the real BV observed. In our sample we observed an average of 72.7 (range: 69.2-77.3, SD: 2.63) and 76.7 (range: 72.3-79.9, SD: 2.18) percent of fat intake on the right and the left breast respectively. No rippling, implant malposition, or infection was observed during a mean follow-up of 22 months (6-40).

CONCLUSIONS

SWEH is a useful surgical alternative that combines the benefits of AFG and implant-based augmentation, particularly with regard to soft tissue coverage, and avoids the limitations of larger-volume implants. The association of small-volume gel implants and smaller scars can yield satisfactory aesthetic outcomes.

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 http://www.springer.com/00266 .

Factors Affecting Lower-pole Stretch after Breast Augmentation

Breast augmentation surgical planning based on soft-tissue characteristics including the type of lower-pole pocket direction has been described. Objective outcome measures of the effects of some of these choices on postoperative lower-pole settling, including dual-plane dissection type, have been lacking.

Quantitative Analysis of Nipple to Inframammary Fold Distance Variation in Tuberous Breast Augmentation: Is there a Progressive Lower Pole Expansion?

INTRODUCTION

In patients with short nipple to inframammary fold (N-IMF) distance, as in tuberous breast, the cohesivity and gel distribution of shaped implants work as a controlled tissue expander, progressively adapting the tissues to the implant's shape. This phenomenon translates into a gradual increase of the N-IMF distance over time, but the true extent to which this occurs has not been quantified to date. This study aims to quantify the postoperative variation of the N-IMF distance in tuberous breast treated with shaped cohesive silicone breast implants.

METHODS

We did a retrospective review of a prospective maintained database of all consecutive patients with bilateral Groulleau I and II tuberous breasts who underwent primary breast augmentation between April 2017 and May 2018 at our institution. To quantify the lower mammary pole's morphological changes, we evaluated the N-IMF distance under maximal stretch as an endpoint. We recorded this value at time 0 (preoperative), immediate post-op (equivalent to the distance planned preoperatively) and at month 1, month 6 and 1-year post-op. Then we calculated the average N-IMF distance variation of our sample of patients with a 99% interval of confidence for each breast obtained. Comparisons were performed using the Sign test and the Mann-Whitney U test.

RESULTS

The average implant weight was 353g (range 290-450; SD ±46.147). Of the 54 breasts analyzed, the immediate post-op N-IMF distance was on average 2.43 cm longer than the preop IMF with a 99% confidence interval between 2.01 and 2.86 and SD of ±1.22. The mean difference between the preop N-IMF distance and after 1, 6 and 12 months was respectively 2.78 cm (SD,1.56) (99% CI, 2.24-3.34), 3.08 cm (SD, 1.57) (99% CI, 2.53-3.64), and 3.36 (1.55) (99% CI, 2.82-3.91) Comparing immediate postoperative nipple to inframammary fold distance (N-IMF) to the 1, 6 and 12 months N-IMF values, an average of 4.23% (CI 1.3-7.16), 7.74% (CI 4.25-11.23) and 10.84% (CI 7.21-14.49) of skin length, was gained respectively. According to implants' weight, subgroup analysis showed that implants > 400 g were associated with significantly higher N-IMF distance increase (p <0.05) compared to implants < 400 g.

CONCLUSIONS

Our findings suggest that a significant progressive postoperative increase in N-IMF distance should be expected in all cases of tuberous breast augmentation with anatomical implants over a 1 year period. This aspect may have an important implication on the IMF incision and the new fold position preoperative planning. LEVEL OF EVIDENCE IV.

The Use of Anatomic Implants in Aesthetic Breast Surgery

Anatomic implants were introduced in the late 1980s, gaining popularity through the 1990s and beyond. The moratorium on silicone meant that the use of theses devices was less diffuse in the US and has remained so. Fifth-generation devices had improved form stability with more aggressive texturization to enhance soft tissue interaction. The ability to vary height, width and projection independently creates much versatility in their use for complex anatomical situations producing natural results. The impact of BIA-ALCL has had a significant impact on their use.

The Kinematics of Breasts Implanted With a Reduced Mass Implant: A Pilot Study

BACKGROUND

Breast implants may increase breast skin tension and interact with surrounding tissues to alter breast position and motion during dynamic activity. Reducing implant mass and changing implant location (submuscular/subglandular) may also affect breast kinematics and the subsequent loads on breast structures.

OBJECTIVES

The aim of this pilot study was to describe the kinematics of breasts augmented with reduced-mass implants during standing, walking, and running, compared with natural breasts, and to provide insight into how implant location (submuscular/subglandular) alters breast kinematics.

METHODS

Two breast augmentation participants (12-15 months postsurgery: 32AA presurgery, anatomical submuscular 255 cc B-Lite reduced-mass implant; 32A presurgery, anatomical subglandular 285 cc B-Lite reduced-mass implant) and 2 natural-breasted participants of similar breast size and anthropometrics were recruited. Nipple and torso positional data were recorded with electromagnetic sensors during standing, walking, and running. Nipple kinematics relative to the torso were calculated.

RESULTS

The B-Lite participants both displayed greater nipple projection and elevation during standing and a 50% reduction in nipple acceleration during walking, when compared with their natural counterparts. During running, the B-Lite subglandular participant displayed decreased nipple kinematics compared with her natural counterpart and lower nipple kinematics compared with the B-Lite submuscular participant during walking and running.

CONCLUSIONS

A combination of implant location (subglandular) and reduced mass minimized nipple kinematics during running. Reducing nipple kinematics during dynamic activity may decrease the loading on breast structures, helping to decrease ptosis and increase the longevity of procedure outcomes.

LEVEL OF EVIDENCE: 4

Composite Buttock Augmentation: The Next Frontier in Gluteal Aesthetic Surgery

BACKGROUND

Despite rapid growth, gluteal fat transplantation has a dismal safety record and often results in inadequate domal projection. Implants alone for gluteal augmentation have also been reported to be less than ideal, with significant complication rates. The idea of combining both implants and fat, as has been described in the breast, was therefore applied to surgery of the buttocks.

METHODS

One hundred forty-seven consecutive cases of buttock augmentation were reviewed. Average follow-up was 18 months. The technique of composite buttock augmentation used progressive instrument dissection to precisely define the correct intramuscular plane of the implant pocket with a minimum amount of pocket access dissection.

RESULTS

Operating times averaged 1 hour 55 minutes. The average volume of fat inserted was 380 cc. The average implant volume was 300 cc. Complications included implant displacements and implant pocket infections requiring surgical intervention. There were no cases of pulmonary thromboembolism, fat embolism, or death.

CONCLUSIONS

Taking a lesson from composite breast augmentation, composite buttock augmentation is a new method for gluteal reshaping that seeks to use the best of both worlds: the reliable core projection of an implant combined with the natural appearance and feel of fat. Progressive instrument dissection seeks to minimize unnecessary dissection and to accurately and safely define the intramuscular pocket. The intramuscular placement of implants instead of fat should eliminate the risk of fatal fat pulmonary embolism in these patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Breast Implant Selection: Consensus Recommendations Using a Modified Delphi Method

Background:

Geographical differences in breast implant selection approaches exist, and clinical data to guide the process are limited. Developing knowledge of implant-related risk factors further complicates the process. This analysis aimed to establish expert consensus on considerations for breast implant selection in Australia and New Zealand based on practice patterns in those countries.

Methods:

A modified Delphi method was used to gain consensus from experts in breast augmentation surgery in Australia and New Zealand. Panelists anonymously completed an initial questionnaire on current considerations in implant selection, discussed a summary of their responses in a live meeting, and completed a final consensus survey based on their live recommendations.

Results:

Seven panelists completed the final consensus survey. Consensus recommendations included ensuring consideration of proper surgical technique (pocket formation, positioning of implant) and patient tissue and anatomical characteristics, weighing relative expected results of various surface textures, sizes, and degrees of cohesivity, and careful contemplation of the migration risk.

Conclusions:

This modified Delphi exercise provided consensus recommendations on the key factors involved in implant selection from the perspective of plastic surgeons with practices in Australia and New Zealand. A primary recommendation was that the choice of implant for each patient should be individualized to patient tissue and anatomical characteristics.

Effects of Silicone Implants on the Mammary Gland: Ultrasonographic and 3D Study

BACKGROUND

Breast implants may be responsible for secondary deformities produced by parenchymal atrophy. However, few studies in the literature have reported changes in breast tissue after augmentation surgery. In this study, the breast thickness of patients undergoing breast augmentation was monitored by ultrasound, and correlations with surface, volume and projection measurements were examined.

METHODS

We studied the parenchymal thickness at the lower pole of the breast with ultrasound in 36 women (72 breasts). In another group of 33 patients (66 breasts), we studied the thickness at the upper and lower poles along the meridian of each breast by ultrasound and measured the anthropometric metrics, volume and projection of the breast with a 3D camera.

RESULTS

Midline measurements close to the areola showed reduced thickness at the lower pole, with 31.8% at the midpoint of the lower pole and 42% at the infra-areolar level (p < 0.0001). At the upper pole, there was a decrease of 14.6% (p < 0.001), but the thickness was increased by 6% and 38% at more cranial levels. No correlations with volume were found. Anatomical implants produced more atrophy at the lower pole, and round implants at the upper pole. More atrophy was found with subfascial than submuscular augmentation. Compared with the expected values, the final volume was very similar, but the projection was 29% less. Surface measurements changed significantly up to 4 months postoperatively and remained stable thereafter.

CONCLUSIONS

Implants affect significatively the thickness of the glandular tissue. All changes occur very soon postoperatively but stabilize after 4 months.

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 .

Reduced Pain and Accelerated Recovery Following Primary Breast Augmentation With Lightweight Breast Implants

BACKGROUND

The posttreatment pain associated with breast augmentation is a top concern of most patients and can affect the decision concerning surgery.

OBJECTIVES

This study aimed to compare the posttreatment pain and recovery times of patients undergoing primary breast augmentation with lightweight vs full-mass implants of similar volumes. The authors hypothesized that the reduced mechanical strain applied by lightweight implants elicits less pain.

METHODS

In this retrospective, observational study, 100 women who had undergone primary breast augmentation with either a lightweight breast implant or a traditional full-mass silicone implant (n = 50), were contacted by phone and asked about their posttreatment experiences and overall satisfaction with the outcome. All women were treated by the same surgical team, and the two groups were matched by date of surgery.

RESULTS

Most patients in the two cohorts had a self-reported preoperative B cup size and relatively high tolerance to pain. On average, LWBI patients were 6 years older than those undergoing full-mass implantation (32.4 ± 8.7 vs 26.2 ± 8.0; P = .0004) and more had experienced at least one pregnancy (61.2% vs 24%, P = .0002). LWBI patients opted for implants 39 ± 28.4 cc larger than patients in the control group. Subglandular placement was selected in most cases (LWBI: 83.7% and full-mass: 90.0%). Mean posttreatment pain was lower in the LWBI cohort (5.5 ± 2.4 vs 6.5 ± 2.4) and required a shorter duration of analgesics (3.87 ± 1.77 days vs 5.26 ± 2.94 days; P = .009). Age- and parity-adjusted measures demonstrated a respective 2-day and 5-day shorter recovery period and return to normal activities interval in the LWBI versus full-mass implant cohorts (P = .04 and P = .002, respectively).

CONCLUSIONS

As compared to traditional silicone filled full-mass implants, breast augmentations with B-Lite lightweight breast implants (G&G Biotechnology Ltd., Haifa, Israel) elicit less posttreatment pain and require less down-time, ultimately, meeting patients' quest for desired breast shape at minimal discomfort.

LEVEL OF EVIDENCE 3

Nipple sparing mastectomy and the evolving direct to implant breast reconstruction

In this paper, we describe the evolving use of the nipple-sparing mastectomy (NSM) and direct to implant breast reconstruction according to existing literature and our own experience. The surgical method enables superior aesthetic results resembling that of a natural breast while maintaining oncologic safety. Acellular dermal matrix enables direct to implant breast reconstruction by serving as a hammock and can be used with acceptable rates of complications. A successful nipple-sparing mastectomy and direct to implant breast reconstruction approach with acceptable postoperative complication rates relies upon quality of the mastectomy skin flaps and correct patient selection. The surgical method has developed with a rapid pace and expected to evolve further in terms of technical modalities, safety measure and lasting results.

The Inframammary Fold (IMF): A Poorly Appreciated Landmark in Prosthetic/Alloplastic Breast Aesthetic and Reconstructive Surgery-Personal Experience

The inframammary fold (IMF) is the most critical visual landmark that affects final aesthetic outcome of augmentation mammoplasty and even post-mastectomy alloplastic breast reconstruction. Unfortunately, structural integrity of this landmark is greatly overlooked and very often neglected. Excessive undermining of the lower breast pole with aggressive disruption/lowering and subsequent poor reconstitution of the IMF scaffold combined with imbalanced implant-tissue dynamics may result in downward implant displacement with creep bottoming and upward tilt of the nipples. The current report reviews the experience of the senior author (BA) over 30 years in breast aesthetic and reconstructive surgery with IMF reconstruction and fixation to the chest wall at the inferior border of the implant. Illustrative cases are presented.

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 .