Ultrastructural features of the double capsulated connective tissue around silicone prostheses.

The implantation of breast prostheses for both aesthetic and reconstructive purposes has been growing exponentially in the last 20 years. Safety and prosthesis lifespan are majorly debated issues in relation to the correlated long-term complications. Mainly the periprosthetic capsule that develops around the implant is often the cause of complications and particularly for macrotextured silicone breast implants. Some reports have tried to elucidate the mechanism by which macrotextured silicone implants undergo damage and cause double capsule formation. In this study, we investigated the morphological characteristics of double capsule of macrotextured implants surgically removed from patients. With the use of microscopy techniques, this work analyzed the newly formed tissue observed in the interaction between synthetic and biological surfaces.

Large-breast reconstruction using fat graft only after prosthetic reconstruction failure.

BACKGROUND: When prosthetic reconstruction fails, and in the case of absolute contraindications to flaps use, no common reconstructive option is available. METHODS: A large irradiated breast was reconstructed using only fat grafts (9 sessions) after prosthetic reconstruction failure (exposure of implant) due to absolute contraindications to general anesthesia and unavailability of large flaps. During the first four sessions small volumes were implanted in the extremely rigid and retracted tissues with regenerative purposes. Larger volumes were implanted during the last five sessions to improve volume and shape. RESULTS: A pleasant aesthetic result was achieved. Tissue regeneration with good vascular support was evident at ultrasonography and magnetic resonance. Histologic and ultrastructural examination of the new tissue showed normal adipose tissue with cell and vasculostromal maturation aspects. No degenerative or inflammatory aspects were present. CONCLUSION: Fat graft transplantation can be a reliable and safe option for breast reconstruction in selected patients.

The serial free fat transfer in irradiated prosthetic breast reconstructions.

BACKGROUND: This study investigated the effects of lipofilling on both the functional and the aesthetic aspects of breast reconstruction. METHODS: Sixty-one consecutive patients with irradiated reconstructed breasts (62 breasts) were offered free fat transfer to enhance the results and correct the defects. Twenty patients were enrolled (active branch) and underwent multiple sessions of lipofilling, while the others were considered controls. The fat was harvested by syringe and processed by saline washing only (no centrifugation). Three months after the last session the functional outcome was evaluated using the LENT-SOMA scoring system and the aesthetic outcome was evaluated using a visual 5-point scale. RESULTS: A significant improvement in all the LENT-SOMA scores after free fat grafting was observed; the scores after treatment were all significantly lower than those before it and were also significantly lower than those of untreated breasts. These results also were confirmed by comparing homogeneous subgroups of breasts with similar LENT-SOMA ranks before treatment. Similarly, the cosmetic outcomes were significantly enhanced after serial lipofilling. The four cases in the active branch with severe flap thinning resolved with no implant exposure (mean follow-up = 17.6 months), while implant exposure occurred in the two cases with the same problem in the control group. In one case, a Baker 3-4 capsular contracture was downgraded to Baker 1 after only one session of lipofilling. No complications occurred in the treated cases. CONCLUSION: Free fat transfer is a safe and reliable technique in improving the outcomes of irradiated reconstructed breasts with implants.

Augmentation mammaplasty of teardrop-shaped breasts using round prostheses.

A new submuscular-subglandular technique to correct teardrop-shaped breasts using round prostheses is presented. In this technique the prostheses are only partially covered by muscle. The muscle is also divided to enhance the projection at the nipple level without the need for anatomical prostheses. A series of 911 implanted prostheses is presented and the results are discussed with regard to both visual and tactile aspects, as well as the dynamic appearance. The complication rates are surprisingly comparable to those of totally submuscular implant techniques. This perhaps suggests that the coverage provided by the divided muscle is sufficient to minimize the contact between the implant and the gland, often considered the primary cause of the higher capsular contracture rates found in techniques using subglandular locations.

Otoplasty: a comparison of techniques for antihelical defects treatment.

BACKGROUND: Prominauris, the most common malformative defect of the external ear, is dependent on a combination of elementary defects mainly affecting the antihelix and the concha. Transection versus cartilage weakening results in antihelix treatment are discussed. METHODS: In this study, 104 ears with antihelical defects were treated in 63 consecutive patients: the 33 patients (53 ears) in group A, received a transection-based treatment, whereas the 30 patients (51 ears) in group B, underwent cartilage weakening and suture. All the patients were treated using a posterior access. The aesthetic results were evaluated by an independent well-trained plastic surgeon. RESULTS: No differences were found in correction degree and stability between the two methods, but cartilage weakening techniques provided a smoother and more natural curvature. CONCLUSIONS: Cartilage weakening techniques can lead to better aesthetic results, primarily because of a softer and more natural ear curvature.

Aesthetic breast reconstruction.

Breast reconstruction is fully justified only from an aesthetic perspective. A reconstructed breast, therefore, should be as aesthetically natural and similar to the contralateral one as possible, even if this means reproducing some little defects. The breast's profile (projection, ptosis, sulcus location, and superficial unevenness), symmetry, areola, and nipple are the characterizing aesthetic factors. The authors present their experience in prosthetic breast reconstruction seen with an aesthetic eye and an artistic touch, illustrating personal tips and technical adjustments: use of anatomical prostheses, pectoralis muscle treatment, sulcus stabilization or reconstruction, superficial irregularities correction, and nipple-areola complex reconstruction. Results are evaluated by both the surgeon and the patient using a score system, validating the method.