Breast Surgery with Smooth Anatomical Implants with Fixation System: A Review of the World's Largest Series of Cases.

BACKGROUND: Anatomical implants continue to be a particularly useful tool in breast surgery, offering an excellent result for certain indications. However, to ensure fixation and prevent rotation, traditional alternatives have medium to high surface roughness and have been controversial in recent years. METHODS: A retrospective assessment of 122 prosthetic augmentation and reconstruction patients over a period of 5 years was conducted. Patients were treated with tabbed anatomical implants with a smooth surface and followed up for a period of 12 months. Demographics, complications, and patient satisfaction were captured. A subgroup of 101 patients were assessed with chest radiographs at 1-year follow-up. Technical recommendations are discussed. RESULTS: Primary breast augmentation, revision augmentation, augmentation-mastopexy, and breast reconstruction were the main indications for surgery. All implants were inserted through an inframammary incision and placed in the subpectoral space using dual-plane techniques, except in one mastectomy case. Rotation of the implants was radiographically observed in only two cases of revision augmentation. None of the 122 patients developed capsular contracture, seroma, rupture, infection, hematoma, or malposition following breast surgery. CONCLUSIONS: Smooth anatomical implants with a fixation system offer reliable and satisfactory results for patients with various diagnoses and indications. The tab system and the fixation technique are essential to provide long-term stability, which was verified by radiographs because of the radiopaque lines present in the device for that purpose. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Aesthetic remodeling of the healthy breast in breast reconstruction using expanders and implants.

BACKGROUND: Breast reconstruction using expanders and implants still is the most common surgical procedure in many hospitals. The most important factor in obtaining a satisfactory aesthetic result for both the patient and the surgeon is to achieve the greatest symmetry possible between the healthy breast and the reconstructed breast. To get a good result, it is necessary to make an exhaustive preoperative examination that facilitates selection of the most suitable technique for remodeling the healthy breast and to choose the most suitable expander for placement on the side to be reconstructed. METHODS: A retrospective study investigated 60 patients submitted to breast reconstruction between October 2005 and January 2008. The study analyzed the characteristics of the healthy breast (e.g., volume, ptosis), which is treated in the first part of the first operation. These characteristics are used later as a model for reconstructing the mastectomy side. The most adequate technique for remodeling the healthy breast based on its characteristics is indicated, as well as techniques not recommended for obtaining the desired symmetry. RESULTS: This study aimed to determine the basis for selecting the most appropriate technique to use in managing the healthy breast and obtaining the most aesthetic result in breast reconstruction. The healthy breast analysis allows an algorithm of indications to be elaborated based on the volume and degree of ptosis exhibited by the healthy breast. The healthy breast should resemble the reconstructed breast with its anatomic implant. In this study, the technique used most often to remodel the healthy breast was reduction surgery with a superomedial pedicle, and glandular flap (autoimplant) (30%). The results were highly satisfactory for both the patient and the surgeon. CONCLUSIONS: Aesthetic remodeling of the healthy breast is the first surgical treatment in breast reconstruction in two stages using expanders and implants. The expander for reconstruction of the other breast then is selected according to the measurements of the healthy modified breast. This reproducible and simple model of breast reconstruction, with its detailed preoperative plan, allows clinicians to obtain a good aesthetic result for breast reconstruction patients.