Implant Size Selection on the Basis of Period, Parity, and Age: A 22-year Retrospective Analysis of 2591 Primary Augmentation Mammoplasties.

The size of implants can be selected objectively or subjectively. However, there is a lack of information on whether there is a change in the trend in implant size selection or whether the parity or the age can have an impact on the implant size used. Methods: A retrospective study to analyze implant size selection following primary augmentation was performed. Data were divided into three groups. Group A had mammoplasties between 1999 and 2011 (group 1) and 2011 and 2022, respectively (group A2). Groups B and C were divided on the basis of age and the number of children. Results: Group A1 included 1902 patients and group A2 included 689 patients. Group B included three subgroups: group B1 included 1345 patients who were 18-29 years old, group B2 included 1087 patients who were 30-45 years old, and group B3 had 127 patients who were 45 years or older. Group C included four subgroups: group C1 had 956 patients without children, group C2 had 422 patients who had one child, group C3 had 716 patients who had two children, and group C4 had 453 patients who had three or more children. Conclusions: The data showed that there was a trend toward larger size implants, and patients with children had larger implants than nulliparous patients. There was no difference seen in implant size used when patients were compared on the basis of age.

Mastopexy using de-epithelialised dermoglandular flaps: a case series for maximal volume conservation following breast implants removal.

AIMS AND OBJECTIVE: Removal of implants without replacement is often requested, and the procedure is more commonly performed today than ever before. However, the resultant loss of body image, secondary to the loss of breast volume, is not an outcome, that a patient is looking forward to. There is a lack of information on the options available to the patients following explantation. This case series presents an option of breast volume preservation and reshaping during mastopexy after breast implant removal that can be offered to selected patients. In the current case series, de-epithelialised dermoglandular flap mastopexy was used as an autologous tissue for breast reshaping and remodelling. MATERIAL AND METHODS: Since 2015, ten patients were selected for de-epithelialised dermoglandular mastopexy using wise pattern or vertical scar. Surgery was performed under general anaesthesia as a day case. A vertically oriented bipedicular dermoglandular flap was used for vertical scar mastopexy in two patients, and eight patients had Wise pattern incisions. Of these eight patients, four had superomedial and four had inferiorly based flaps for dermoglandular mastopexy and closure. All patients had a preoperative cup size D or larger. RESULTS: All patients had adequate results with an acceptable breast cup size. There was no skin breakdown, nipple loss, haematoma or infection. CONCLUSION: De-epithelialised dermoglandular flap mastopexy is a safe procedure and can be used as an option in selected patients. LEVEL OF EVIDENCE: IV.

Pectoral Muscle Re-Attachment with Breast Implant Removal.

Breast implant removal is an increasingly requested procedure. An uncommon but important reason for this is breast animation deformity (BAD). Although methods such as the split muscle have been used for prevention and correction of animation deformity successfully for many years, [1, 2] we occasionally see patients who have undergone explantation and present with unresolved animation. These patients have had prior unsuccessful attempts at correction by further muscle release, and explantation was done as a final attempt at resolution. We regard muscle re-attachment as key to correction of animation. Herein we present illustrative cases and discuss technical points.

Muscle Splitting Augmentation Mastopexy: A l3-year Analysis and Outcome of Primary and Secondary Procedures.

BACKGROUND: The muscle splitting technique is a submuscular pocket used for augmentation mammoplasty. Its use and results following primary and secondary procedures are presented. METHODS: A retrospective study that analyzed complication and revision rates following primary and secondary mastopexy with augmentation in a muscle splitting pocket performed between April 2007 and March 2020 was carried out. Data were divided into two groups: primary and secondary single-stage mastopexies with augmentation. RESULTS: A total of 169 patients had a primary procedure and 49 had secondary procedures. The mean ages of patients in the primary and secondary were 32.3 ± 9.89 and 38.2 ± 9.63 years, respectively. Five (3.0%) patients had periprosthetic or wound infections in the primary group when compared with 0% in secondary surgery group. Wound breakdown was seen in 13 (7.7%) patients with a primary procedure compared with one patient (2%) with a secondary procedure. One patient had partial nipple loss and another had total nipple loss in the primary group (1.2%) when compared with one patient (2.0%) who had partial nipple loss in the secondary group. Revision surgeries were carried out in 16 (10.1%) of the primary procedures compared with five (10.2%) of the secondary procedures. CONCLUSION: Even though there was a higher prevalence of complications in the primary procedures group than in the secondary procedures group, the overall complications following muscle splitting mastopexy with augmentation are within an acceptable range.

Layered Mastopexy with Augmentation in Muscle Splitting Biplane: A Modification for Lower Pole Safety and Stability.

BACKGROUND: Single-stage mastopexy with augmentation is a commonly performed procedure. The single-stage procedure can be performed in primary cases or a secondary procedure in patients with previous history of augmentation, mastopexy or mastopexy with augmentation. The procedure is challenging and not without its risks. METHODS: A retrospective chart review of all consecutive cases of layered mastopexy with augmentation mammoplasties, carried out from September 2015 to August 2019, was performed. All patients had their implants placed in muscle splitting pocket first and access for the pocket was closed prior to the commencement of mastopexy. RESULTS: During the period of 4 years, 102 consecutive layered mastopexy with augmentations were performed in muscle splitting plane. Of these 102 patients, 74 (72.5%) patients had it as a primary and 28 (27.5%) as a secondary procedure. Of these 102 patients, 53 (52.0%) had textured, 37 (36.3%) had smooth and 12 (11.8%) had microtextured implants and 72 (70.6%) patients had high profile and 30 (29.4%) had medium profile implants. Same size implant was used in 89 patients with a mean of 298 cc, and 13 patients had different size implants with a mean of 362 cc on the right and 395 cc on the left. In current study, bilateral periareolar, vertical scar cat's tail and Wise pattern mastopexies were performed in 11, 51 and 27 patients, respectively. Of the 102 patients, 5 had unilateral right periareolar, 5 unilateral right vertical scar cat's tail, 2 unilateral left periareolar and 1 patient had a combination of periareolar and vertical scar combination. There was no nipple loss or periprosthetic infection. There was a minor wound breakdown seen in 4 (3.9%), haematoma in 2 (2.1%), nipple sensation loss in 2 (2.1%) and 12 (11.8%) had layered mastopexy as a part of a combined procedure. Revision was performed in 6 (6.5%), drains were used in 14 (13.7%), and 92 (90.2%) had the procedure performed as a day case. CONCLUSION: Layered mastopexy with augmentation is a safe procedure with added stability and safety to lower pole of the breast as well as nipple-areolar complex. 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 .

Revisionary Surgery Following Primary Augmentation Mammoplasty in Muscle Splitting Biplane Pocket: An Appraisal of 93 Revisionary Surgeries.

BACKGROUND: Muscle splitting augmentation mammoplasty is the creation of a submuscular pocket which is gaining attention and acceptance by plastic surgeons worldwide. First introduced in 2007, muscle splitting augmentation mammoplasty has since been used for primary and secondary augmentation mammoplasty and augmentation mastopexy procedures. A personal experience of revision surgeries following muscle splitting augmentation mammoplasty is presented. METHODS: A retrospective data analysis for revision surgeries, following muscle splitting primary augmentation mammoplasties, performed between October 2005 and October 2018 was carried out. RESULTS: A total of 1511 primary augmentation mammoplasties were performed. Of these 1511 patients, 93 (6.1%) patients had revisionary or secondary surgery. The mean age of the patients was 33.8 + 9 years (range 20-60). Of the 93 patients, 78 patients had same size implants, mean 337 cc + 53.5 (range 230-495), and 14 had different size implants. Of these 14 patients, mean implant size on right and left was 331 cc + 59.4 (range 225-425) and 351 cc + 61.7 (range 260-450), respectively. Of the recorded texturing in 1495 patients, only 3.1% had smooth implants. Leading causes for revision were implant exchange for various reasons, in 33 (35.4%); 25 (26.8%) wanted larger implants, revisionary surgery for capsular contracture in 18 (19.3%), implant rupture was seen in 9 (9.6%), 4 (4.3%) patients had surgery for recurrent back-to-front flipping, 2 (2.1%) patients wanted a smaller size, 1 (1.07%) patient had fold flaw failure, and in 1 (1.07%) the cause was not recorded. There were no haematoma and breast implant-associated anaplastic large cell lymphoma (BIA ALCL) recorded in the series. CONCLUSION: The incidence of revisionary surgery following muscle splitting primary augmentation mammoplasty is acceptable and can be corrected using the described techniques. 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 .

Periprosthetic Infection in Primary and Secondary Augmentation Mammoplasty Using Round Silicone Gel Breast Implants: Comparative Analysis of 2521 Primary and 386 Secondary Mammoplasties in a Single Surgeon Practice.

INTRODUCTION: Wounds are generally classified as clean, clean contaminated, contaminated and dirty. Aesthetic surgery, including breast augmentation, is classified as clean or clean contaminated. The presence of bacteria on the skin, in nipple secretions, in superficial and deep parenchymal samples and also the presence of bacteria in capsules and on implants justifies the use of antibiotics. However, there is a paucity of information about whether added bacterial flora on the capsule of the implant pockets, and the handling of these capsules as capsulotomy or capsulectomy makes secondary augmentation mammoplasty more prone to wound healing issues or periprosthetic infection. The current study is the analysis carried out between primary and secondary augmentation mammoplasties to look at the incidence of periprosthetic infection between the two groups. MATERIAL AND METHODS: A retrospective data analysis for periprosthetic infection and wound healing issues following primary and secondary augmentation mammoplasties performed between April 1999 and April 2019 was carried out. RESULTS: A total of 2521 (5042 breasts) primary and 386 (772 breasts) secondary augmentation mammoplasty data were available for analysis. Periprosthetic infection was seen in 0.7% and 0.5% of the primary and secondary augmentations, respectively, with no significant difference. Wound healing issues were significantly higher in primary augmentation mammoplasty. CONCLUSION: There was a marginally higher incidence of periprosthetic infection in primary augmentation mammoplasty as compared to secondary augmentation mammoplasty; however, the difference was not significant. On the contrary, the wound healing and superficial skin issues were higher in primary as compared to secondary augmentation mammoplasty, and the difference was statistically significant. 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 .

Muscle Splitting Augmentation Mammoplasty: A 13-Year Outcome Analysis of 1511 Primary Augmentation Mammoplasties.

BACKGROUND: Augmentation mammoplasty is a commonly performed procedure by plastic surgeons with a high satisfaction outcome. Muscle splitting augmentation mammoplasty was first described in 2007 and has been since used for primary and secondary augmentation mammoplasty as well as for primary and secondary augmentation mastopexy procedures. METHODS: A retrospective analysis of data for muscle splitting primary augmentation mammoplasties performed between October 2005 and October 2018 was carried out. RESULTS: A total of 1511 patients had their primary augmentation mammoplasty consecutively performed in muscle splitting pocket. Mean age of the patient was 29.4 ± 8.56 years (range 18-67). Of the 1502 patients with documented implant sizes, 1272 patients had same-size implants, mean 340 cc ± 58.3 (range 170-700), and 230 patients had two different-size implants for correction of asymmetry. Of these 230 patients, mean implant size on right and left was 341 cc ± 61.5 (range 200-655) and 345 cc ± 67.4 (range 200-605), respectively. Of the 1495 known texturing, only 3.1% patients had smooth implants. Periprosthetic infection was seen in 10 patients, 38 patients had wound-healing issues and 5 patients had late seroma. Capsular contracture (CC) was recorded at three monthly, six monthly, one yearly and two yearly or longer period. Secondary procedures were performed for various reasons in 93 (6.15%) of the patients. Leading causes for revision were implant exchange in 33 (2.2%), to go for bigger size in 25 (1.65%), CC in 18 (1.2%) and implant rupture in 9 (0.6%). There was no ALCL recorded in the series. CONCLUSION: Muscle splitting pocket for primary augmentation mammoplasty is a reliable, reproducible procedure with acceptable revision rate. 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 Authorswww.springer.com/00266.

Poly Implant Prothèse (PIP) incidence of device failure and capsular contracture: a retrospective comparative analysis.

BACKGROUND: The Medicine and Healthcare Products Regulatory Agency in the United Kingdom issued a Medical Device Alert (MDA/2010/025) through a press release on 31 March 2010 for clinicians not to use the Poly Implant Prothèse (PIP) implant. METHODS: Data were collected to analyze PIP and non-PIP implant failures as well as rates of capsular contracture between August 2008 and August 2012. Relevant data were retrieved for 143 patients with PIP (group A) and non-PIP (group B) implants. RESULTS: Group A (PIP): A total of 65 patients had PIP implants removed. The mean patient age was 37.1 ± 8.1 years (range 24-53 years). The mean duration of the implant was 7.2 ± 2.5 years (range 2-12 years), and the mean preoperative implant size was 327.1 ± 69.6 ml (range 255-495 ml). Of the implants in 65 patients, 18 (27.7 %) were damaged, and of the 64 patients with recorded capsular contractures, 16 (25 %) presented with grades 3 and 4 capsular contractures. Group B (non-PIP): A total of 79 patients had non-PIP implants removed. The mean patient age was 34.4 ± 8.0 years (range 19-54 years). The mean implantation time was 5.8 ± 3.9 years (range 0.2-26 years), and the mean preoperative implant size was 348.2 ± 79.0 ml (range 175-555 ml). Of the 79 patients, 6 had ruptured implants (7.6 %) and 21 (26.6 %) presented with grades 3 and 4 capsular contractures. There were no statistically significant differences in mean patient age (p = 0.046), preoperative size of the implants (p = 0.095), duration of the implantation (p = 0.08), or grades 3 and 4 capsular contractures (p = 0.830). The incidence of implant rupture was significantly higher with the PIP implants than with the non-PIP implants (p = 0.01). CONCLUSION: The PIP implants were more prone to rupture than the other implants, although the incidence of clinical capsular contracture (grades 3 and 4) was not increased.

Muscle-splitting, subglandular, and partial submuscular augmentation mammoplasties: a 12-year retrospective analysis of 2026 primary cases.

BACKGROUND: Augmentation mammoplasty is a commonly performed procedure with a very high satisfaction rate. Various techniques have been described since the report of the first augmentation mammoplasty in 1963. Muscle-splitting augmentation mammoplasty, a technique first published in 2007, has been used by the author for primary and secondary augmentation mammoplasties and for mastopexy with augmentation. METHODS: A retrospective analysis of data prospectively collected using the Excel spreadsheet was performed. The patients were divided into three groups. The mammoplasty for group A used the subglandular pocket. In group B, the partial submuscular pocket was used for mammoplasties. Both of these groups had their mammoplasties performed between 1999 and 2005. Group C, the third group, included patients who had muscle-splitting mammoplasties between 2005 and 2011. RESULTS: Group A involved 793 patients who had their augmentation mammoplasties in the subglandular pocket. Of these 793 patients, 751 had the same size implants and were included in the analysis. The mean age of the patients in group A was 30.9±7.98 years (range 18-59 years), and their mean implant size was 317.5 cc±2.05 (range 200-555). In group A, 45.1% (n=339) of the patients were smokers, and 62.2% (n=467) had drains. The majority of the patients (78%) had an overnight stay in the clinic. Hematoma was seen in 2.7% (n=20) of the group A patients. Revision was performed for 6% (n=45). Periprosthetic infection was seen in 0.4% (n=3) and minor wound healing problems in 1.3% (n=10). Group B comprised 110 patients who had mammoplasties performed in partial submuscular pockets. All the patients had the same size implants. The mean age of the group B patients was 33±8.26 years (range 20-58 years), and their mean implant size was 300.6 cc±35.92 (range 205-395). Of these 110 patients, 51.8% (n=57) were smokers, and 94.5% (n=104) had drains. Hematoma was seen in 1.8% (n=2), and revision was performed for 7.3% (n=8) in the submuscular subgroup. Infection was seen in 3.6% (n=4) and minor wound healing problems in 4.5% (n=5). Group C consisted of 1,123 patients who had breast augmentation in the muscle-splitting biplane. Of these 1,123 patients, 914 had the same size implants. The mean age of the patients was 30.0±8.78 years (range 18-67 years), and their mean implant size was 338.2 cc±58.01 (range 170-655). In group C, 33.6% of the patients were smokers, and 8 % had drains. The majority of the patients (93.4%) were treated as day cases. Hematoma was seen in 0.7%, and 1.2% of the patients had revision surgery. Infection was seen in 1.6% (n=15) and minor wound healing in 4% (n=45). CONCLUSION: Muscle-splitting mammoplasty is a technique that can be performed as a day case without drains. The overall complications in the group were significantly lower than with the other two techniques performed by the author. LEVEL OF EVIDENCE IV: This journal requires that authors assign a 41 level of evidence to each article. For a full description of 42 these Evidence-Based Medicine ratings, please refer to the 43 Table of Contents or the online Instructions to Authors 44 http://www.springer.com/00266 .

Secondary augmentation mammaplasties and periprosthetic infection: a three-year retrospective review.

BACKGROUND: Secondary or revision surgery following primary augmentation mammaplasty is common. There are several published studies on the incidence and prevention of infection after primary augmentation mammaplasty, but there is a paucity of information on the incidence of periprosthetic infection after secondary or revision augmentation mammaplasty procedures. OBJECTIVES: The author evaluates the incidence of periprosthetic infection in a series of revision and secondary mammaplasty patients from his practice. METHODS: A retrospective review was performed of the charts for 92 consecutive patients who underwent bilateral secondary mammaplasty with the author between July 2008 and April 2011. Each breast was taken as a single unit, for a total of 184 breasts. The data were compiled and compared with previous studies related to periprosthetic infection following primary augmentation mammaplasty. RESULTS: The average age of the patients was 35.8±7.9 years (range, 19-54 years). One patient developed unilateral periprosthetic infection in her left breast. This incidence of 0.54% was comparable to infection incidence of 0.5% for primary augmentation mammaplasty previously reported by the author. CONCLUSIONS: In this series, there was no higher incidence of infection seen in secondary augmentation mammaplasty than was seen in previous studies on primary mammaplasty. LEVEL OF EVIDENCE: 4.

High transverse capsuloplasty for the correction of malpositioned implants following augmentation mammoplasty in partial submuscular plane.

BACKGROUND: Breast augmentation is one of the most commonly performed procedures today. The complications are few and can be divided into early or late. Early complications include infection and haematoma often requiring emergency interventions. Capsular contracture and implant malplacement are the most common late complications and both can be treated with an elective procedure. Capsular contracture is easily recognised due to change in the breast's physical characteristics, shape, and accompanying tenderness. On the other hand, implant malplacement, though more common than capsular contracture, is often undertreated. The aim of this study was how to recognise and treat malpositioned implants in a partial submuscular pocket with or without animation or dynamic deformity. METHODS: Retrospective data were collected from the pool of revision breast surgeries, and patients with double-bubble deformities and malpositioned implants in the partial submuscular pocket accompanied with varying degrees of dynamic deformity were identified. RESULTS: Ten patients with malpositioned implants with varying degrees of animation deformity underwent high transverse capsuloplasty for a new pocket creation. The size of the new implants ranged from 350 to 595 cc. All were treated as day cases. With a follow-up period ranging from 1 to 6 years, all patients had good results and a stable new pocket. No revision was required in any of the procedures performed within a follow-up period of at least 1 year. CONCLUSION: The high transverse capsuloplasty is an extension of an already described technique and can be used in selected patients with malpositioned implants with or without animation deformity following partial submuscular breast augmentation. Large-volume implants should be used with caution in these patients.

Vertical scar mastopexy with a cat's tail extension for prevention of skin redundancy: an experience with 17 consecutive cases after mastopexy and mastopexy with breast augmentation.

BACKGROUND: Mastopexy with or without augmentation is a commonly performed procedure. Marking, orientation of the flap and, in simultaneous augmentation, pockets for the implants can be selected in any combination. Vertical scar mastopexy, with or without augmentation, is commonly performed, with a high revision rate for skin redundancy. A new technique called the "cat's tail" extension of the vertical scar is a simple modification developed to avoid this complication. METHODS: Vertical scar was treated by mastopexy with or without augmentation using modified cat's tail extension markings in 17 consecutive cases (14 mastopexies with augmentation and 3 mastopexies alone). All the patients had a medially based flap, and all the procedures were performed on a day case basis without drains by a single surgeon. RESULTS: No hematomas or infections occurred after the procedure. During a follow-up period of 4 weeks to 1 year, all the patients had satisfactory results, with no skin redundancy in the immediate or late postoperative period. One patient had a superficial areolar necrosis in the lower half of the left nipple-areola complex and was treated conservatively. No other complications related to implant, implant pocket, breast envelope, or flap orientation were seen. CONCLUSION: The cat's tail marking is a simple modification of the vertical scar mastopexy that eliminated redundant skin in the current series.

Augmentation mastopexy in muscle-splitting biplane: outcome of first 44 consecutive cases of mastopexies in a new pocket.

BACKGROUND: Augmentation with mastopexy is a commonly performed procedure and is done either simultaneously or in stages. The augmentation component can be accomplished by placing an implant in the subglandular, partial submuscular, or subfascial plane, and mastopexy can be performed using periareolar, vertical, or Wise pattern markings. These two components are independent of each other and any pocket can be combined with suitable external markings. The muscle-splitting submuscular biplane is a new pocket and is combined with conventional envelope reductions for mastopexy. METHODS: The submuscular biplane pocket was used in 44 consecutive patients for mastopexy and augmentation using vertical scar and periareolar markings. Of these, 13 had subglandular augmentation in the past. The mean age of the patients was 32.4 years (range = 21-46). Average blood loss was 44 g (range = 10-111 g). Drains were used selectively and the procedure was usually done as a day case. RESULTS: The follow-up period of the included cases ranged from 4 months to 3 years. No infection, hematoma, or wound problems were seen. Minor revision was required for periareolar puckering in one case and three had dog-ears after vertical scar mastopexy. One periareolar mastopexy required conversion into a vertical scar as a revision and one vertical scar mastopexy had superficial infection with bilateral minor skin breakdown which responded completely to antibiotics. CONCLUSION: The submuscular biplane technique is a good option for breast augmentation with mastopexy as a single or staged procedure.

Breast augmentation, antibiotic prophylaxis, and infection: comparative analysis of 1,628 primary augmentation mammoplasties assessing the role and efficacy of antibiotics prophylaxis duration.

BACKGROUND: Infections after augmentation mammoplasty are not uncommon, and prophylactic antibiotics are routinely administered to minimize infection. However, there is paucity of information on the relationship between the length of prophylaxis cover and its benefits in primary augmentation mammoplasty. A retrospective analysis of different antibiotic cover regimens, their effectiveness in preventing infections, and the management of infection in established cases is reviewed. METHODS: A retrospective chart analysis of periprosthetic infections in primary augmentation mammoplasties performed over the past 10 years was conducted. Periprosthetic infection was determined by the presence of pain, swelling, redness, and discharge. Each breast was taken as an individual unit in 1,628 patients, and data for 3,256 breasts were analyzed. The patients had their augmentation in the partial submuscular plane (214 breasts in 107 patients), the subglandular plane (1,548 breasts in 774 patients), and the muscle-splitting biplane (1,494 breasts in 747 patients). All the patients had soft round cohesive gel silicone implants. Of the 3,256 implants, 3,218 were textured, and 38 were smooth surfaced. The patients received antibiotics as a single intravenous dose of cephalosporin (474 breasts in 237 patients), a single intravenous dose plus an oral dose for 24 h (344 breasts in 172 patients), or a single intravenous dose plus an oral course for 5 days (2,438 breasts in 1,219 patients). Infection was recorded as superficial (e.g., wound breakdown, stitch extrusion, stitch abscess) or deep (periprosthetic). The patients with established periprosthetic infections, determined clinically by the presence of pain, discharge, swelling, and redness of the breasts, were managed either conservatively using antibiotics, passive wound drainage, and healing of the wound with secondary intention or by explantation and replacement after 3 to 4 months. In selected cases of periprosthetic infection, the implants were removed after a course of antibiotics and negative swab cultures. The cavity was washed thoroughly with betadine and saline, and new implants were simultaneously reimplanted. RESULTS: The incidence of infection was lowest with a single perioperative dose of intravenous antibiotic compared with a combination of intravenous and oral antibiotics. Superficial infection was seen in 38 breasts (all unilateral), with an incidence of 1.2%, and periprosthetic infection was observed in 17 breasts (13 unilateral and 2 bilateral), giving an infection incidence of 0.52% (p = 0.002). In patients with a single intravenous dose of antibiotic, superficial and periprosthetic infection was seen in four breasts (0.8%) and no breasts, respectively. The difference was not significant (p = 0.13). The patients receiving a single intravenous antibiotic and a 24-h oral antibiotic had superficial and periprosthetic infection rates of 2.3% (8 breasts) and 0.3% (1 breast), respectively, and the difference between the two sub-groups was significantly higher (p = 0.04). The patients receiving an intravenous antibiotic and 5 days of oral antibiotics had superficial and periprosthetic infection rates of 1.1% (26 breasts) and 0.65% (14 breasts), respectively. The difference between the two subgroups was not significant (p = 0.09). Of the 17 periprosthetic infections in 15 patients (13 unilateral and 2 bilateral), 11 breasts (1 bilateral and 9 unilateral) were treated conservatively using antibiotics, passive drainage, and wound healing with secondary intention. Capsular contracture developed in two of the conservatively treated breasts, requiring capsulotomies with change of implants. Of the six periprosthetic infections in six patients, requiring surgical intervention, two implants were treated using explantation with immediate replacement after a course of antibiotics and a negative culture, and two implants were explanted followed by reimplantation later. One patient had both implants removed after unilateral infection, and no reimplantation was performed. One patient had a bilateral infection. In this case, one implant was explanted and the other was treated conservatively. The patient had bilateral reimplantion 6 months later, and bilateral Baker 4 capsular contracture developed in both breasts within 6 months. No other complications were seen in the patients who underwent surgery. CONCLUSION: A single dose of intravenous antibiotic is adequate for prophylaxis in breast augmentation surgery, and the extra duration of antibiotic cover does not result in reduced superficial or periprosthetic infections. Infection can be managed in more than one way depending on the nature, degree, and extent of infection.

Mondor disease: a case report and review of the literature.

Thrombophlebitis of the thoracoepigastric system of veins is a benign disease and, despite its localized involvement and presentation, the condition is known as Mondor disease (MD). A transverse incision made on the thoracoabdominal wall divides the axially arranged superficial veins at a right angle and the presence of unidirectional valves prevents retrograde blood flow, leading to stasis and thrombus formation. The incidence of MD in oncologic breast cases and aesthetic mammaplasties is reported to be 0.95% and 1.07%, respectively. Siliconeadenitis of axillary nodes, on the other hand, is uncommon and has only been reported occasionally. Extensive MD of the left axilla and inner arm is presented following excision of axillary nodes secondary to siliconeadenitis after cohesive gel silicone breast implant rupture.

Correction of acquired synmastia with muscle-splitting biplane implant replacement.

BACKGROUND: Synmastia following mammoplasty is an uncommon complication. The true incidence is not known and the condition is underrecorded and undertreated. Medial capsulorrhaphy is the treatment of choice and can be accomplished in a single or staged procedure. Muscle-splitting submuscular biplane is used to correct synmastia following subglandular mammoplasty. The procedure allows the use of undisturbed submuscular anatomy and obviates the need for capsulorrhaphy. METHODS: A retrospective single-surgeon record of over 1900 implant-related surgeries included five patients treated for synmastia. Four had their primary surgery done by the author and one was a secondary referral. Only one patient was aware of the condition and revision was done exclusively for synmastia. The other patients requested bigger implants without being aware of the condition. All five had their mammoplasty done in the subglandular plane and the pocket was changed to a muscle-splitting biplane without capsulorrhaphy. One patient had associated bottoming down and so her inframammary crease was relocated and repaired with multilayer capsulorrhaphy of the lower pole only. RESULTS: All five patients had acceptable results after synmastia correction.