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Boyd CJ, Chiodo MV, Lisiecki JL, Wagner RD, Rohrich RJ. Systematic Review of Capsular Contracture Management following Breast Augmentation: An Update. Plast Reconstr Surg 2024; 153:303e-321e. [PMID: 36877620 DOI: 10.1097/prs.0000000000010358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Capsular contracture is one of the most frequent indications for revision following breast augmentation. Management goals focus on restoring breast aesthetics and minimizing subsequent recurrence of capsular contracture. As new data emerge, close review of the data are merited to build evidence-based clinical guidelines to inform surgical practice and management of capsular contracture. METHODS A systematic review of the MEDLINE, Embase, and Cochrane Database of Systematic Reviews databases was conducted to characterize the surgical management of capsular contracture in revision breast augmentations. The primary endpoint was capsular contracture recurrence rate. RESULTS The review was conducted in November of 2021. Primary search revealed 14,163 results. Initial screening by title left 1223 articles. Abstract review left 90 articles for full-text review, of which 34 were ultimately included and were all observational in nature. CONCLUSIONS Capsular contracture management remains an important topic, with limited high-level evidence for establishing clear evidence-based treatment guidelines. Although more evidence is required to assess the effects of capsulectomy, implant exchange, and plane change, these appear to be useful mechanisms for reducing recurrent capsular contracture. There is more evidence regarding the use of acellular dermal matrix, although this still requires long-term follow-up studies. New developments regarding textured implants limit the revision breast augmentation surgeon to smooth devices.
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Affiliation(s)
- Carter J Boyd
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone
| | | | | | - Ryan D Wagner
- Division of Plastic Surgery, Baylor College of Medicine
| | - Rod J Rohrich
- Dallas Plastic Surgery Institute
- Division of Plastic Surgery, Baylor College of Medicine
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2
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Myckatyn TM, Duran Ramirez JM, Walker JN, Hanson BM. Management of Biofilm with Breast Implant Surgery. Plast Reconstr Surg 2023; 152:919e-942e. [PMID: 37871028 DOI: 10.1097/prs.0000000000010791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand how bacteria negatively impact aesthetic and reconstructive breast implants. 2. Understand how bacteria infect breast implants. 3. Understand the evidence associated with common implant infection-prevention strategies, and their limitations. 4. Understand why implementation of bacteria-mitigation strategies such as antibiotic administration or "no-touch" techniques may not indefinitely prevent breast implant infection. SUMMARY Bacterial infection of aesthetic and reconstructive breast implants is a common and expensive problem. Subacute infections or chronic capsular contractures leading to device explantation are the most commonly documented sequelae. Although bench and translational research underscores the complexities of implant-associated infection, high-quality studies with adequate power, control groups, and duration of follow-up are lacking. Common strategies to minimize infections use antibiotics-administered systemically, in the breast implant pocket, or by directly bathing the implant before insertion-to limit bacterial contamination. Limiting contact between the implant and skin or breast parenchyma represents an additional common strategy. The clinical prevention of breast implant infection is challenged by the clean-contaminated nature of breast parenchyma, and the variable behavior of not only specific bacterial species but also their strains. These factors impact bacterial virulence and antibiotic resistance.
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Affiliation(s)
- Terence M Myckatyn
- From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | | | - Jennifer N Walker
- Department of Microbiology and Molecular Genetics
- Center for Infectious Diseases, Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston
| | - Blake M Hanson
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School
- Center for Infectious Diseases, Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston
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Bojanic C, Samaras S, Chishimba MM, Malata CM. First use of Braxon® acellular dermal matrix for complex revision aesthetic breast surgery-revision augmentation mastopexy. J Surg Case Rep 2021; 2021:rjab256. [PMID: 34211692 PMCID: PMC8241462 DOI: 10.1093/jscr/rjab256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/24/2021] [Indexed: 01/15/2023] Open
Abstract
Acellular dermal matrices (ADMs) have ushered in a paradigm shift in prosthetic breast reconstruction; however, there has hitherto been no reported use of Braxon® ADM in aesthetic breast surgery. Here, we describe the case of a 42-year-old woman who presented for revision of her bilateral aesthetic augmentation-mastopexy following multiple revision surgeries. The predominant concerns were persistent pain, implant malposition and a wide intermammary distance. Her predicament was worsened by inability to tolerate monopolar diathermy owing to a spinal stimulator-the least invasive operation was sought and Braxon® ADM met this criterion. The procedure was a success, and she remains symptom-free, with soft breasts and stable implant positions. Braxon® ADM, with its preformed shape, total implant-wrapping design and easy suture fixation, lends itself to easy use in cosmetic breast surgery. Its role in cosmetic breast surgery has yet to be established, but this case marks the beginning of this endeavor.
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Affiliation(s)
- Christine Bojanic
- Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stavros Samaras
- Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Charles M Malata
- Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Montemurro P, Pellegatta T, Pafitanis G. 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. J Plast Reconstr Aesthet Surg 2021; 74:3307-3315. [PMID: 34210625 DOI: 10.1016/j.bjps.2021.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 03/20/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Paolo Montemurro
- Akademikliniken,Storängsvägen 10, 11452 Stockholm, Stockholm, Sweden.
| | | | - Georgios Pafitanis
- Akademikliniken,Storängsvägen 10, 11452 Stockholm, Stockholm, Sweden; Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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5
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Revisional Breast Surgery: Are Surgical Plans Changed if the Patient Has a Textured Device? Plast Reconstr Surg 2021; 147:31S-38S. [PMID: 33890878 DOI: 10.1097/prs.0000000000008043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY The authors reviewed the available evidence on revision surgery following implant-based breast surgery with the aim of investigating whether any difference in the surgical approach should be proposed if the patient has a textured device. They included in their review 31 studies presenting different approaches for revision surgery following implant-based breast surgery (both aesthetic and reconstructive), with a level of evidence ranging from 4 to 5. None of the included studies proposed different surgical approaches for revision surgery in patients carrying textured devices. The authors conclude that no different surgical attitudes in revision surgery following implant-based breast surgery should be adopted if the patient has a textured device according to the available evidence, when a correct approach is performed to face the complication or adverse event, following a thorough preoperative study of the patient with the proper diagnostic tools.
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Bengtson BP. Commentary on: Capsulectomy, Implant Exchange, and Placement of Acellular Dermal Matrix is Effective in Treating Capsular Contracture in Breast Augmentation Patients. Aesthet Surg J 2021; 41:313-317. [PMID: 33346784 DOI: 10.1093/asj/sjaa267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tork S, Jefferson RC, Janis JE. Acellular Dermal Matrices: Applications in Plastic Surgery. Semin Plast Surg 2019; 33:173-184. [PMID: 31384233 DOI: 10.1055/s-0039-1693019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Modern advances in tissue engineering have transformed the plastic surgeon's management strategies across a wide variety of applications. Comprehension of the fundamentals of biologic constructs is critical to navigating the available armamentarium. It is essential that plastic surgeons become familiar with some of the existing methods for utilizing biologics as well as the advantages and limitations to their use. In this article, the authors describe the basic science of biologics with a focus on acellular dermal matrices (ADMs), and review the recent evidence behind their use for a variety of reconstructive and aesthetic purposes. The review is organized by system and examines the common indications, techniques, and outcomes pertaining to the application of ADMs in select anatomic areas. The final section briefly considers possible future directions for using biologics in plastic and reconstructive surgery.
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Affiliation(s)
- Shahryar Tork
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Ryan C Jefferson
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey E Janis
- Department of Plastic Surgery, University Hospitals, Wexner Medical Center, Ohio State University, Columbus, Ohio
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Abstract
Reconstructive breast surgery is challenging and continually evolving. In the past decade, numerous soft tissue adjuncts, such as acellular dermal matrices (ADMs), have revolutionized breast reconstruction serving as a tool to improve results and minimize the need for revision. The use of ADMs has been widely discussed in primary and secondary breast reconstruction after mastectomy. They have been shown to be an effective and safe option to correct complications; however, there is a relative paucity of literature on their use in revisional surgery after aesthetic breast procedures. The authors queried PubMed for existing literature regarding the use of ADMs in secondary breast surgery. Five case series from an initial search of 278 articles met the inclusion criteria. An overall infection rate of 2% and a complication rate of implant malposition was 0.8% with the use of ADMs. Although the literature is sparse regarding their use in this setting, early reports indicate that they are both safe and efficacious with a reasonable rate of complications.
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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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Abstract
BACKGROUND Buttock implant studies have focused largely on safety, efficacy, and complication rates of primary surgery. The revision buttock implant surgical experience has to date not been published. METHODS A retrospective chart review was conducted to collect data from patients who underwent revision buttock implantation surgery performed by the author over a 12-year period from June of 2003 through December of 2015. Inclusion criteria consisted of any patient for whom an implant was either removed and replaced, exchanged, or repositioned after prior buttock implant surgery. The indications, types of procedures, and results of revision buttock implantation surgery based on the author's experience are described. RESULTS Forty-three patients (32 women and 11 men) underwent revision buttock implantation surgery. Indications included replacement after removal (n = 18), asymmetry (n = 16), and size change (n = 9). Revision buttock implantation procedures included implant removal (n = 24), implant replacement (n = 19), implant exchange (n = 18), capsulotomy (n = 6), site change (n = 5), and capsulorrhaphy (n = 1). The overall complication rate was 17.8 percent. Complications were highest after unilateral implant replacement (n = 5). CONCLUSIONS Revision buttock implantation is often necessary to correct or improve the results of primary buttock augmentation. Implants should be removed as soon as diagnosed in case of infection to reduce additional complications and permit successful reimplantation. Surgeons performing buttock implant surgery should be aware of the common indications, surgical procedures, and complications associated with revision buttock implantation surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Chopra K, Gowda AU, Kwon E, Eagan M, Grant Stevens W. Techniques to Repair Implant Malposition after Breast Augmentation: A Review. Aesthet Surg J 2016; 36:660-71. [PMID: 26988217 DOI: 10.1093/asj/sjv261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Implant malposition is a complication of breast augmentation that adversely affects aesthetic outcomes. It is one of the most common reasons for revisionary aesthetic breast surgery yet there is a lack of peer reviewed literature dedicated to the management of this complication. OBJECTIVES The purpose of this article was to summarize the malposition literature, review the types and causes of this complication, and evaluate the strengths and weakness of procedures aimed at addressing it. METHODS A review of the literature was performed using the PubMed database. Articles describing surgical techniques for correction of implant malposition, as well as outcome data for patients undergoing revision with described techniques, were included. Articles describing revisionary surgery following breast reconstruction were excluded. A series of cases are presented to illustrate techniques discussed. RESULTS Search criteria resulted in 763 articles. Title and abstract review followed by application of inclusion and exclusion criteria resulted in a total of 21 clinical studies from 1988 to 2014 that were included in this review. All studies included in this study were of level IV or V evidence. CONCLUSIONS Despite the overall low level of evidence in the literature regarding secondary breast augmentation, a thorough understanding of the corrective techniques presented will allow surgeons to make the most informed judgments. Weighing the strengths and weakness of these surgical techniques in the context of each patient will allow surgeons to develop the most appropriate treatment strategy. LEVEL OF EVIDENCE 4: Therapeutic.
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Affiliation(s)
- Karan Chopra
- Dr Chopra is a Plastic Surgery Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic and Reconstructive Surgery, The University of Maryland, Baltimore, MD. Dr Gowda is a Plastic Surgery Research Fellow, Division of Plastic and Reconstructive Surgery, University of Maryland, Baltimore, MD. Drs Kwon and Eagan are Aesthetic Surgery Fellows and Dr Stevens is a Clinical Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA
| | - Arvind U Gowda
- Dr Chopra is a Plastic Surgery Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic and Reconstructive Surgery, The University of Maryland, Baltimore, MD. Dr Gowda is a Plastic Surgery Research Fellow, Division of Plastic and Reconstructive Surgery, University of Maryland, Baltimore, MD. Drs Kwon and Eagan are Aesthetic Surgery Fellows and Dr Stevens is a Clinical Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA
| | - Edwin Kwon
- Dr Chopra is a Plastic Surgery Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic and Reconstructive Surgery, The University of Maryland, Baltimore, MD. Dr Gowda is a Plastic Surgery Research Fellow, Division of Plastic and Reconstructive Surgery, University of Maryland, Baltimore, MD. Drs Kwon and Eagan are Aesthetic Surgery Fellows and Dr Stevens is a Clinical Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA
| | - Michelle Eagan
- Dr Chopra is a Plastic Surgery Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic and Reconstructive Surgery, The University of Maryland, Baltimore, MD. Dr Gowda is a Plastic Surgery Research Fellow, Division of Plastic and Reconstructive Surgery, University of Maryland, Baltimore, MD. Drs Kwon and Eagan are Aesthetic Surgery Fellows and Dr Stevens is a Clinical Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA
| | - W Grant Stevens
- Dr Chopra is a Plastic Surgery Resident, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; and the Division of Plastic and Reconstructive Surgery, The University of Maryland, Baltimore, MD. Dr Gowda is a Plastic Surgery Research Fellow, Division of Plastic and Reconstructive Surgery, University of Maryland, Baltimore, MD. Drs Kwon and Eagan are Aesthetic Surgery Fellows and Dr Stevens is a Clinical Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA
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13
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Maclin MM, Deigni OA, Bengtson BP. The Laminated Nature of the Pectoralis Major Muscle and the Redefinition of the Inframammary Fold: Clinical Implications in Aesthetic and Reconstructive Breast Surgery. Clin Plast Surg 2015; 42:465-79. [PMID: 26408437 DOI: 10.1016/j.cps.2015.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The breast is appreciated aesthetically and clinically for its shape, projection, and volume. Surgical techniques have evolved to manipulate the breast skin envelope, soft tissues, and chest wall anatomy, with and without prosthetic devices. The pectoralis major specifically is altered for pocket dissection and implant coverage. Both the aesthetic and reconstructive surgeons are aware of its relationship to the chest wall and the breast soft tissues. Both are able to achieve outstanding outcomes; however, the authors present an alternative appreciation of the pectoralis and its relationship to the breast.
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Affiliation(s)
- Melvin M Maclin
- Parkcrest Plastic Surgery, 845 North New Ballas Court, Suite 300, St Louis, MO 63141, USA.
| | | | - Bradley P Bengtson
- Bengtson Center for Aesthetics & Plastic Surgery, Michigan State University, East Lansing, MI, USA
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14
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Critical Evaluation of Risk Factors and Early Complications in 564 Consecutive Two-Stage Implant-Based Breast Reconstructions Using Acellular Dermal Matrix at a Single Center. Plast Reconstr Surg 2015; 136:10-20. [PMID: 26111310 DOI: 10.1097/prs.0000000000001327] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acellular dermal matrix for implant-based breast reconstruction appears to cause higher early complication rates, but long-term outcomes are perceived to be superior. This dichotomy is the subject of considerable debate. The authors hypothesized that patient characteristics and operative variables would have a greater impact on complications than the type of acellular dermal matrix used. METHODS A retrospective cohort study was performed of consecutive patients who underwent two-stage, implant-based breast reconstruction with human cadaveric or bovine acellular dermal matrix from 2006 to 2012 at a single institution. Patient characteristics and operative variables were analyzed using logistic regression analyses to identify risk factors for complications. RESULTS The authors included 564 reconstructions in the study. Radiation therapy and obesity increased the odds of all complications. Every 100-ml increase in preoperative breast volume increased the odds of any complication by 1 percent, the odds of infection by 27 percent, and the risk of explantation by 16 percent. The odds of seroma increased linearly with increasing surface area of acellular dermal matrix. Odds of infection were higher with an intraoperative expander fill volume greater than 50 percent of the total volume. Risk of explantation was twice as high when intraoperative expander fill volume was greater than 300 ml. CONCLUSIONS Radiation therapy, obesity, larger breasts, higher intraoperative fill volumes, and larger acellular dermal matrices are all independent risk factors for early complications. Maximizing the initial mastectomy skin envelope fill must be balanced with the understanding that higher complication rates may result from a larger intraoperative breast mound. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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15
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Ibrahim AMS, Koolen PGL, Ganor O, Markarian MK, Tobias AM, Lee BT, Lin SJ, Mureau MAM. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction? Aesthetic Plast Surg 2015; 39:359-68. [PMID: 25894022 DOI: 10.1007/s00266-015-0484-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The expectation for improved results by women undergoing postmastectomy reconstruction has steadily risen. A majority of these operations are tissue expander/implant-based breast reconstructions. Acellular dermal matrix (ADM) offers numerous advantages in these procedures. Thus far, the evidence to justify improved aesthetic outcome has solely been based on surgeon opinion. The purpose of this study was to assess aesthetic outcome following ADM use in tissue expander/implant-based breast reconstruction by a panel of blinded plastic surgeons. METHODS Mean aesthetic results of patients who underwent tissue expander/implant-based breast reconstruction with (n = 18) or without ADM (n = 20) were assessed with objective grading of preoperative and postoperative photographs by five independent blinded plastic surgeons. Absolute observed agreement as well as weighted Fleiss Kappa (κ) test statistics were calculated to assess inter-rater variability. RESULTS When ADM was incorporated, the overall aesthetic score was improved by an average of 12.1 %. In addition, subscale analyses revealed improvements in breast contour (35.2 %), implant placement (20.7 %), lower pole projection (16.7 %), and inframammary fold definition (13.8 %). Contour (p = 0.039), implant placement (p = 0.021), and overall aesthetic score (p = 0.022) reached statistical significance. Inter-rater reliability showed mostly moderate agreement. CONCLUSIONS Mean aesthetic scores were higher in the ADM-assisted breast reconstruction cohort including the total aesthetic score which was statistically significant. Aesthetic outcome alone may justify the added expense of incorporating biologic mesh. Moreover, ADM has other benefits which may render it cost-effective. Larger prospective studies are needed to provide plastic surgeons with more definitive guidelines for ADM use. 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)
- Ahmed M S Ibrahim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,
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Spring MA, Macias LH, Nadeau M, Stevens WG. Secondary augmentation-mastopexy: indications, preferred practices, and the treatment of complications. Aesthet Surg J 2014; 34:1018-40. [PMID: 25168806 DOI: 10.1177/1090820x14543943] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Increasing the volume of the breast while simultaneously decreasing the skin envelope equates to surgery involving opposing forces. Increasing patient demand and the evolving perceptions of surgeons have led to the growing popularity of the combined augmentation-mastopexy operation. In turn, secondary augmentation-mastopexies and revisional surgeries of primary augmentation-mastopexies also have increased in popularity. In this article, the authors describe indications for secondary augmentation-mastopexy, techniques for performing this combined procedure safely and effectively, adjunctive procedures, potential pitfalls, and the treatment of complications.
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Affiliation(s)
- Michelle A Spring
- Drs Spring and Macias are Clinical Assistant Professors of Surgery and Dr Stevens is a Clinical Professor of Surgery in the Keck School of Medicine at the University of Southern California in Los AngelesDr Nadeau is an Aesthetic Surgery Fellow at the University of Southern California in Los Angeles
| | - Luis H Macias
- Drs Spring and Macias are Clinical Assistant Professors of Surgery and Dr Stevens is a Clinical Professor of Surgery in the Keck School of Medicine at the University of Southern California in Los AngelesDr Nadeau is an Aesthetic Surgery Fellow at the University of Southern California in Los Angeles
| | - Meghan Nadeau
- Drs Spring and Macias are Clinical Assistant Professors of Surgery and Dr Stevens is a Clinical Professor of Surgery in the Keck School of Medicine at the University of Southern California in Los AngelesDr Nadeau is an Aesthetic Surgery Fellow at the University of Southern California in Los Angeles
| | - W Grant Stevens
- Drs Spring and Macias are Clinical Assistant Professors of Surgery and Dr Stevens is a Clinical Professor of Surgery in the Keck School of Medicine at the University of Southern California in Los AngelesDr Nadeau is an Aesthetic Surgery Fellow at the University of Southern California in Los Angeles
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