The High Five Process: tissue-based planning for breast augmentation.

Despite popularity, breast augmentation has not advanced significantly in 20 years. The re-operation data for breast augmentation has been excessive at 15% to 20% in every Federal Drug Administration pre-market approval study for the past 15 years. Recently, a more scientific approach to breast augmentation has described a true process approach to this procedure. One element, tissue-based pre-operative planning, has been shown to reduce re-operation rate to less than 3% in published peer-reviewed studies. The High Five process was published in 2005 and codifies the 5 most important pre-operative decisions made during a breast augmentation procedure. Application into clinical practice of this planning system is discussed.

Safely re-integrating silicone breast implants into the plastic surgery practice.

In the early 1990s, it was reported that silicone breast implants were possibly responsible for serious damage to women's health. In January 1992, the Food and Drug Administration issued a voluntary breast implant moratorium and, in April, issued a ban on the use of silicone gel-filled implants for cosmetic breast augmentation. Since that time, silicone gel-filled breast implants have been available to women only for select cases: women seeking breast reconstruction or revision of an existing breast implant, women who have had breast cancer surgery, a severe injury to the breast, a birth defect that affects the breast, or a medical condition causing a severe breast deformity. Since the ban on the use of silicone gel-filled breast implants for cosmetic breast augmentation, numerous scientific studies have been conducted. To ensure patient safety, the American Board of Plastic Surgery believes that these scientific studies and the Food and Drug Administration's scrutiny of silicone gel-filled breast implants have been appropriate and necessary.

Implantes mamarios en el plano subfascial en reemplazo del bolsillo subglandular: un cambio lógico / Breast implants in the subfascial plane in replacement of the subglandular pocket: a logical change

Desde 1999 hemos cambiado el plano subglandular del bolsillo de los implantes mamarios por el plano subfascial (subaponeurótico). Este plano se halla por debajo de la fascia aponeurótica del músculo pectoral mayor, serrato, oblicuo lateral y recto anterior. Este artículo considera 150 casos implantados en este plano (subfascial). Se utilizaron prótesis de superficie texturada. El abordaje fue por una incisión periareolar inferior. En todos los pacientes se consiguió una excelente cobertura del implante, al igual que una forma y movilidad natural. En ningún caso se observó el desagradable ondulado de cuadrantes superiores, conocido como rippling. Cuatro de ellos presentaron procesos capsulares contráctiles grado II de Baker (2,6%). En el postoperatorio inmediato se registró menor edema y una recuperación más rápida de lo habitual, de acuerdo a nuestra experiencia con los otros procedimientos (submuscular y subglandular). Cuando la elección del bolsillo es subglandular, el plano subfascial parecería ser el lugar lógico de la colocación de los implantes mamarios (AU)

Since 1999, the subglandular plane of the pocket has been substituted in our practise for the subfascial (subaponeurotic) plane in breast implants. This plane lies underneath the aponeurotic fascia of the pectoralis major , the serratus, the lateral oblique and the rectus anterior muscles. This article describes 150 patients with implants in the subaponeurotic plane and textured surface. Patients were approached through an inferior periareolar incision. Excellent coverage of the implant, as well as natural shape and mobility were achieved in all patients. No ondulation (rippling) in the upper half of the breast has been observed. Four patients (2,6%) had Baker grade II capsular contracture. In the immediate post-op, less edema and faster-than-usual recovery could be seen versus our experience with other (submuscular and subglandular) procedures. When a subglandular pocket is the choice, the subfascial plane would seem to be the logical place for breast implants (AU)

Conventional or adhesive external breast prosthesis? A prospective study of the patients' preference after mastectomy.

After having been subjected to radical mastectomy for breast cancer, women are usually fitted with an external breast prosthesis. Different types of prostheses are available, but oncology nurses have few data enabling them to advise their patients adequately. In this prospective randomized crossover study of 101 women undergoing one-sided mastectomy for breast cancer, the self-adhesive breast prosthesis was compared with the traditional external prosthesis. Questionnaires were used to evaluate the woman's judgment of the prosthesis in relation to her final preference for one type of prosthesis. Complete data were available for 91 women, 59.3% of whom finally preferred the self-adhesive type. Preference was independent of age, randomization, order, or the possible use of adjuvant chemotherapy. Satisfaction with the self-adhesive prosthesis was independent of randomization order but satisfaction with the traditional type was significantly more when it was the first type of prosthesis. Preference for the self-adhesive prosthesis over the traditional type mas mainly related to an increased perception of the prosthesis as a part of the body. Preference for the traditional prosthesis over the other type was mainly related to the greater ease of application and the lesser local irritation of the skin. Findings from this study can be useful in oncology nursing practice.

[A scanning electron microscopy study of the surface of porous-textured breast implants and their capsules. Description of the "velcro" effect of porous-textured breast prostheses]. / Etude au microscope électronique à balayage des surfaces des implants mammaires à texturation poreuse et de leurs capsules. Description de l'effet "velcro" des prothèses à texturation poreuse.

The efficacy of breast prosthesis texturing in the prevention of capsular contracture has been established for about 20 years. This successful procedure has led to the development and marketing of a number of different models. In the present study, four porous-textured breast prostheses have been examined: the Arion monoblock implant, the CUI (McGahn), the Biocell (Mcgahn), and the Sebbin LS21. Scanning electron microscopic (SEM) investigation of the implant surfaces of the different prostheses was carried out on new samples received from the manufacturers. During a prospective study on eight patients, capsule samples corresponding to the four above-mentioned prostheses were taken to determine whether a secondary intervention was necessary for correction of asymmetry or malpositioning. These samples were analyzed by SEM to investigate whether there could be a correlation between prosthesis texturing and the aspect of the corresponding capsules. Significant ultrastructural differences were found between the various prostheses examined: the results showed that only the CUI and Biocell prostheses presented a mirror image of the capsule texturing, with a correspondence between the depressions on the prosthesis and the contacts on the capsule. This finding seems to be linked to the existence of a critical size for the pores that constitute the implant surface. This observation led to the hypothesis of an adhesive "velcro" effect between the prosthesis and its capsule. Although the latter may not be directly linked to the prevention of capsular contracture it can, however, have a major effect on implant stabilization in cases of primary breast reconstruction and in possible secondary adjustments of asymmetry and malpositioning.

Do women have equitable access to quality breast prosthesis services?

Although up to 90% of women who have had a mastectomy use breast prostheses, significant gaps exist around current breast prosthesis services for Australian women. These gaps include the timeliness and quality of information provision, the disparity in financial assistance, and the lack of knowledge regarding the determinants of what constitutes a "quality" breast prosthesis. Revised policy initiatives are central to addressing these gaps to ensure equitable access to quality breast prosthesis services.

[Survivorship of breast implants used in breast reconstruction. 949 implants]. / Durée de vie des implants mammaires en reconstruction mammaire. A propos de 949 implants.

The authors present from a series of 949 implants their method to calculate the life span of a mammary implant in the framework of breast reconstruction after cancer. In this statistical study, they have calculated the median life span of breast implants (loss of half of staff) by distinguishing it according to each type of implant (content, brand, indication...). The global median life span of a breast implant is 127 months. The median life span of a silicone gel-filled implant is superior than a saline implant because the frequency of deflation of saline implants is more important than the first one, despite that the real rupture percentage of silicone gel-filled implants is under-evaluated by the number of asymptomatic rupture. For saline implants, the median life span is clearly decreased by the initial under-inflation (108 months against 127 months) doubling the secondary deflation risk. In this series, the authors have been able to compare the evolution of implants according to their initial indication (reconstruction or aesthetic) and sometimes at a same patient, they have not observed significant difference of the median life span over a period of five years for an implant used in breast reconstruction after cancer or for an implant used in symmetricalization. In this series, the life span of saline implants is significant different in function of the brand of the implant demonstrating the comparative study usefulness by brands.

[Breast implants: state of the controversy]. / Implants mammaires: état de la question.

The controversy that occurred during the 1990 years concerning the breast implants has revealed several new problems, related to comfort surgery. Considering that this surgery has developed considerably, we found useful to outline the difficulties and the drifts that appeared with the breast implants. They were present at all levels: patients, implant factories, judges and lawyers, media, certified laboratories. An increased vigilance was found to be necessary in order to provide the safety and the quality of this type of surgery.

Silicone breast implants: implications for society and surgeons.

In the last two years, scientific studies have confirmed that there is no significant increase in risk of subsequent breast cancer, connective-tissue disease or symptoms in women with silicone gel-filled breast implants. Despite this evidence, a moratorium (in place since 1992) on the use of these prostheses in the United States has been maintained by the pressure of overwhelming litigation. At the same time, Australian authorities also announced a moratorium, restricting the availability of silicone breast implants. Huge damages awarded by United States courts forced Dow Corning, manufacturer of a large percentage of breast prostheses, to file for Chapter 11 bankruptcy in May 1995. This effectively terminated the major source of implantable silicone for medical use. The withdrawal of implantable silicone and other implantable prosthetic material will be a significant loss for surgeons and society. This paper will highlight the consequences if reasoned scientific data are not relied on by Australian courts to assess claims for damages relating to medical devices.

Women and saline breast implant surgery.

Since clinical studies are ongoing relative to breast implants, keeping up with the most current information is an important aspect of nursing practice. This article will provide answers to five basic questions that arise in regards to breast implantation and nurses' roles in the process.