Autologous Collagen Matrix (ACM): Lower Pole Support With a Supero-Anterior Capsular Flap in Secondary Subpectoral Breast Augmentation

Transaxillary Capsulorrhaphy with Reimplantation to Correct Bottoming-Out Deformity in Breast Mycobacterial Periprosthetic Infection: A Case Report with Literature Review

Augmentation mammoplasty is one of the most popular cosmetic surgeries, but there is a high reoperation rate (29.7%) commonly due to capsular contracture, implant malpositioning, infection, and unsatisfactory size. Although infection only accounts for 2% of cases, its management is very challenging, especially with nontuberculous mycobacteria (NTM) infection. Breast prosthetic NTM infection is a rare but is a disastrous condition with an incidence of approximately 0.013%. Immediate salvage reimplantation is usually not suggested, and most studies recommend a gap of 3 to 6 months after combination antibiotics therapy before reimplantation. However, delayed reimplantation often leads to great psychological stress and struggle between the doctor and patient. We present the case report of successful reimplantation in treating prosthetic NTM infections in a 28-year-old female. We discuss a novel technique "transaxillary capsulorrhaphy" to correct the bottoming-out deformity. One year after the combination of antibiotics and surgery, the follow-up computed tomography scan showed complete remission of NTM without recurrence. We discuss the surgical technique in detail. The 1-year follow-up assessment (photos and dynamic video) revealed good cosmesis and reliable correction using the new technique. This report is the first formal description and discussion of one-stage reimplantation following NTM infections. Transaxillary capsulorrhaphy allows for a successful salvage operation when an implant is displaced. This approach provides highly favorable result in eastern women undergoing revision augmentation mammoplasty. This study reflects level of evidence V, considering opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.

The effect of implant surface on the recurrence rates of capsular contracture following revision breast surgery: Early results from a single surgeon retrospective comparative study

INTRODUCTION

This retrospective comparative study aimed to evaluate the effect of implant surface in two cohorts of consecutive patients who underwent revision surgery following capsular contracture (Baker III-IV) after primary breast augmentation with textured implants.

METHODS

All patients underwent the same surgical procedure (capsulectomy - pocket plane change - implant exchange) and the only difference was that two different types of implants were used during the implant exchange: textured(Group A - biocell) or nanotextured(Group B - silksurface). A comparative analysis was performed using the following parameters: patients' demographics, age, the time between the primary breast augmentation and the revision surgery, the surgical and follow-up outcomes; and the incidence, timing, and capsular contracture recurrence.

RESULTS

Eighty consecutive females were included, Group A(textured): age of 35(19-65) years and time between primary and secondary surgery of 59(6-209) months; and Group B(nanotextured): age of 39(26-58) years and time between primary and secondary surgery of 65(7-218) months. For both groups, at a mean follow-up of 25(21-36) months for Group A(textured), and at a mean follow-up of 24(21-34) months for Group B(nanotextured); capsular contracture reoccurred in 3 cases (7.5%), at 7, 10, and 14 months in Group A and in 3 cases (7,5%), at 9, 10, and 16 months in Group B, post revision surgery. Students' t-test demonstrated no statistically significant differences between the recurrences of the two implant surfaces (p-value>0.05).

CONCLUSION

In capsular contracture revision surgery, the type of implant surface (textured or nanotextured) does not appear to influence recurrence rates. Further studies are required to identify the clinical impact on the implant surface in long-term outcomes of capsular contracture breast surgery.

Secondary Breast Augmentation: Is There a Trend for Bigger Implants?

BACKGROUND

Despite novel assessment tools and 3D simulation, patient's desire for implant size change is one of the most common reasons for revision surgery after primary breast augmentation. In this study, we analysed outcomes and predictive indicators for revision surgeries in a cohort of patients operated on by a single surgeon.

PATIENTS AND METHODS

All consecutive patients who underwent revision augmentation surgery between 2013 and 2017 by the first author were included in this study. Besides review of medical records, subgroups based on the indication for revision surgery were compared and statistically analysed.

RESULTS

A total of 110 patients were included in this study. Revision surgery was performed 97.2 months on average after primary augmentation. Eighty-six per cent of patients received larger implants. Indications for revision surgery and associated subgroups were: (1) wish for bigger implants (38%), (2) complication + wish for bigger implants (26%), (3) complication (29%), (4) complication + wish for smaller implants (3%) and (5) wish for smaller implants (3%). Subgroup analysis showed that patients who underwent revision surgery for bigger implants were significantly younger compared to patients who suffered a complication or desired smaller implants. Time to secondary augmentation was significantly shorter in case of wish for size change compared to complications as reason for revision surgery. Implant sizes differed significantly in patients where volume change was the sole indication for surgery compared to revisions performed due to complications.

CONCLUSION

In our cohort of patients, almost all patients who underwent revision surgery after primary breast augmentation received bigger implants. Patients who specifically wished for size change were younger, asked for surgery earlier and received larger volumes compared to patients who underwent revision surgery for other reasons.

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 .