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Pontello J, Roxo AC, Abreu ML, Torezani R, Pamplona D. Relation Between Post-Augmentation Parenchymal Atrophy and Local Tissue Pressure. Aesthet Surg J 2021; 41:NP1486-NP1495. [PMID: 34096996 DOI: 10.1093/asj/sjab242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast parenchyma interacts dynamically with an inserted implant, which may lead to local atrophy and sensory involvement, changes in vascular tissue and lactation, and volume reduction over time. The inversely proportional relationship between pressure and volume cannot be stated with certainty; that is, the larger implants having more local pressure would lead to compression, thus leading to atrophy of parenchyma more intensely compared with smaller implants. The objective of this study was to assess and list breast parenchyma volume changes with different pressure levels due to silicone implants of several sizes. OBJECTIVES The authors sought to list the pressure exerted by silicone implants and the atrophy caused in the breast tissue. METHODS Thirty-six women were placed in 3 groups (n = 12) and subjected to augmentation mammoplasty in the subglandular plane. The measurement of pressure in millimeters of mercury was conducted with help of molds with the same base and projection of implants introduced posteriorly. MRI was conducted in all participants in the preoperative period and at 6 and 12 months after surgery. RESULTS Twelve months after breast implant insertion, the groups had a significant glandular volume reduction (mean, 12.97% in the right breast and 12.42% in the left breast). There was a statistically significant difference in the proportions of volume reduction and the pressure levels measured. CONCLUSIONS A reduction in breast volume was verified. This reduction was also related to the level of pressure exerted on the implant. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- João Pontello
- Division of Plastic Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ana Claudia Roxo
- Division of Plastic Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Maria Lidia Abreu
- Division of Plastic Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Rodrigo Torezani
- Division of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Djenane Pamplona
- Division of Mechanical Engineering PUC RIO, Rio de Janeiro, Brazil
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Avvedimento S, Montemurro P, Cigna E, Guastafierro A, Cagli B, Santorelli A. Quantitative Analysis of Nipple to Inframammary Fold Distance Variation in Tuberous Breast Augmentation: Is there a Progressive Lower Pole Expansion? Aesthetic Plast Surg 2021; 45:2017-2024. [PMID: 34100102 DOI: 10.1007/s00266-021-02363-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/15/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
| | | | - Emanuele Cigna
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italy
| | - Antonio Guastafierro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Barbara Cagli
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome", Rome, Italy
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Lin F, Hong W, Zeng L, Kong X, Feng W, Luo S. A Prospective Study of Breast Morphological Changes and the Correlative Factors After Periareolar Dual-Plane Augmentation Mammaplasty with Anatomic Implant. Aesthetic Plast Surg 2020; 44:1965-1976. [PMID: 32152710 DOI: 10.1007/s00266-020-01665-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dual-plane breast augmentation is a popular cosmetic procedure. However, objective evaluations on the effects of dual-plane breast augmentation on breast morphology are lacking. This study evaluated the breast morphological changes and correlative factors after dual-plane anatomic implant augmentation with a periareolar incision via a Vectra 3-dimensional (3D) scanning technique. METHODS The dynamic changes in linear distance, breast projection, nipple position, and breast volume and surface over time (preoperatively; 1 month, 3 months, 6 months, and 12 months after surgery) were analyzed in 21 patients with the Vectra 3D scanning technique. In another group of 65 patients, the influence of the implant parameters and tissue characteristics of the patients on breast morphological changes were evaluated. RESULTS The breast measurements changed significantly up to 6 months postoperatively and remained stable thereafter. The inframammary fold dropped by 0.8 cm at 1 month postoperatively and by 0.5 cm in the following 11 months. The preoperative implant volume and a lower pole skin elasticity lead to an increase in the nipple-to-inframammary fold distance. Compared with the expected values, the final volume was 10.9% smaller, and the projection was 25% smaller. Both the reduced volume and projection were correlated with the implant parameters and preoperative values. The nipple level was slightly elevated by approximately 0.8 cm. CONCLUSIONS This study provides objective information regarding the breast morphological changes and correlative factors after dual-plane breast augmentation. These information may help to further understand the operation effects of dual-plane breast augmentation and to guide medical practice. 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)
- Fuchuan Lin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Weijin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Li Zeng
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiangxue Kong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wenjie Feng
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shengkang Luo
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China.
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Roxo AC, Nahas FX, Pinheiro Rodrigues NC, Salles JI, Amaral Cossich VR, de Castro CC, Aboudib JH, Marques RG. Functional and Volumetric Analysis of the Pectoralis Major Muscle After Submuscular Breast Augmentation. Aesthet Surg J 2017; 37:654-661. [PMID: 28333173 DOI: 10.1093/asj/sjw239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dual plane breast augmentation is a technical variation of the submuscular plane described as a technique that reduces contour deformities due to contraction of the pectoralis major muscle and lower risk of double-bubble deformity associated with breast ptosis. Despite improvement in the aesthetic aspect, there is still no consensus whether this technique affects the function of the pectoralis major muscle. OBJECTIVES The aim of this study was to correlate functional with volumetric changes associated with dissection of the muscle origin in submuscular breast augmentation. METHODS Thirty women who desired to undergo breast augmentation were selected prospectively and randomly allocated to 2 groups: 10 patients in the control group and 20 patients in the interventional group, who underwent submuscular breast augmentation. Magnetic resonance imaging and volumetric software were used to assess muscle volume and isokinetic dynamometry was used to assess function of the pectoralis major muscle. Preoperative measurements were compared with those at 3, 6, and 12 months after surgery. RESULTS Magnetic resonance imaging revealed significant decrease in muscle volume at 6 and 12 months follow-up. The isokinetic test conducted during adduction showed a significant difference in muscle strength between groups from baseline to the 12-month follow-up, and between the 3- and 12-month follow-up. No significant differences in muscle strength during abduction were observed from baseline to the 3-, 6-, and 12-month follow-up. CONCLUSIONS Submuscular breast augmentation reduced muscle strength during adduction 12 months after surgery, but without a significant correlation with volumetric muscle loss. LEVEL OF EVIDENCE 2
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Affiliation(s)
- Ana Claudia Roxo
- Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
| | - Fabio Xerfan Nahas
- Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
| | - Nadia Cristina Pinheiro Rodrigues
- Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
| | - José Inácio Salles
- Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
| | - Victor Rodrigues Amaral Cossich
- Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
| | - Claudio Cardoso de Castro
- Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
| | - Jose Horacio Aboudib
- Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
| | - Ruy Garcia Marques
- Dr Roxo is a Plastic Surgeon, and Drs de Castro and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Nahas is an Associate Professor, Division of Plastic Surgery, Paulista School of Medicine, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil. Dr Rodrigues is an Associate Professor, Division of Statistics, Pedro Ernesto University Hospital, UERJ, Rio de Janeiro, Brazil. Dr Salles is Head and Prof Cossich is a Researcher, Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil. Dr Marques is an Associate Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, University of State of Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
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