Single centre, long-term experience with Mentor Contour Profile Gel Implants. What can we learn after 21 years of follow up?

BACKGROUND: The difficulty in obtaining long term data with the use of breast implants is well known. The majority of available data are multicentre studies with different surgical techniques, and different implants. METHOD: We provide a retrospective 10-year study data (2001 to 2011) with Mentor® Contour Profile Gel (CPG TM) implants after a mean of 13 years of follow-up, in the first single-centre study of such size and length. This study included 835 patients with 1674 Mentor implants across six surgery types, all of them operated with a consistent surgical technique developed by the senior author. Long term complication rates were analysed. For the safety analysis, Kaplan-Meier risk rates were calculated. RESULTS: 85% of the patients had long term follow up data (at least 7 years). The overall complication rate was 13,2%. The reoperation rate was 12,3%, being just 6,4% due to complications. The 21-year Kaplan Meier cumulative incidence rate was 1,7% for capsular contracture and 5,7% for implant rupture. Periareolar approach and having a previous capsular contracture were found to be risk factors to develop a new capsular contracture. Low height, high projected implants had a significant higher risk of implant rotation. No BIA-ALCL nor BII cases were found. 89,2% of the patients reported to be satisfied or very satisfied with the surgery and the implant. CONCLUSION: With a consistent surgical technique, this 21-year follow-up data of the MENTOR ® CPG™ reaffirm the very strong safety profile of these implants, as well as continued patient satisfaction with them.

Breast augmentation with anatomic implants: a method based on the breast implantation base.

UNLABELLED: Currently, aesthetic and reconstructive surgery of the breast should be considered in terms of contouring, and hence in terms of dimensions. Based on experience performing more than 5,000 breast augmentations with highly cohesive anatomic implants, the authors explore the aesthetic anatomy of the (augmented) breast and explain the importance of the breast implantation base (BIB), the aesthetic proportions of the lower breast pole, and the patient's somatotype in the implant selection for a natural-appearing breast augmentation. A method is described for transferring all these concepts and proportions to the preoperative marking of the individual patient. 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 .

Stiffness, compliance, resilience, and creep deformation: understanding implant-soft tissue dynamics in the augmented breast: fundamentals based on materials science.

BACKGROUND: Postoperative tissue stretch deformities are among the possible complications in breast augmentation. These deformities are responsible for many potential risks such as bottoming-out deformity, breakdown of the inframammary fold, permanent tissue atrophy, sensory loss, and breast distortion (visible implant edges and traction rippling), among others. Although the elastic properties of the breast are a major concern for plastic surgeons, concepts such as stiffness, compliance, elasticity, and resilience have not been sufficiently defined or explored in the plastic surgery literature. METHODS: Similar to any other material, living tissues are subject to the fundamentals of the mechanics of materials. Based on their experience with more than 5,000 breast augmentations, the authors explored the basic fundamentals of the mechanics of materials in search of a rational explanation for long-term results in breast augmentation and augmentation-mastopexy. RESULTS: A basic law of the mechanics of materials determines that when a material (e.g., breast) is loaded with a force (e.g., implant), it produces a stress that causes the material to deform (e.g., breast augmentation), and this behavior might be graphed in a theoretical material's stress-stress curve. This deformation will increase with time although the load (implant) remains constant, a concept termed "creep deformation." Because the breast, like all human tissues, is a viscoelastic material, the application of concepts such as elastic and plastic deformation, stiffness, compliance, resilience, and creep deformation can and should be applied to breast augmentation surgery. CONCLUSIONS: The authors have found that the principles of the mechanics of materials can provide plastic surgeons with some clues for a predictable, long-lasting good result in breast augmentation and augmentation-mastopexy. Future studies are needed to develop these concepts and evaluate how they might individually determine the mid- and long-term outcomes of augmented breasts.