The Breast Implant ARC: An Algorithm for Determining the Position of the IMF in Breast Augmentation Planning.

In breast augmentation surgery, many techniques have been developed and advocated to achieve the best possible results in incision planning. The standard dimensions on which most algorithms are based are width, height and the projection of the silicone gel-filled implants. The ARC is introduced as a new dimension instead of the currently used anatomical silicone gel-filled implants parameters. The algorithm presented in this article is based on the amount of breast parenchyma (P) and the ARC of an anatomical silicone gel-filled implant to obtain an exact positioning of the incision at the new inframammary fold. A patient case is presented to demonstrate the use of the algorithm. To date, this technique has been used in over 1200 patients with reproducible and consistent results. 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.

Three-dimensional laser imaging as a valuable tool for specifying changes in breast shape after augmentation mammaplasty.

BACKGROUND: Three-dimensional (3D) terrestrial laser scanning (TLS) is a valuable method for measuring shapes of objects and for obtaining quantitative measurements. These qualities of the 3D laser scanner have proved to be useful in reconstructive breast surgery. This study investigated various 3D parameters to obtain an optimal objective visualization of the breast after cosmetic augmentation mammaplasty. METHODS: The objects are represented in a point cloud, which comprises millions of x, y, and z coordinates representing a virtual image. The quantification of 3D points shows changes in height (z coordinate) at any chosen point on the augmented breast (x and y coordinates). To give visual feedback on the change in dimensions, a color elevation scheme was applied on the reconstructed surface of the breast. As a quantifying description, a sagittal B-spline was chosen in a plane through the nipple to obtain the breast shape via the lateral profile. RESULTS: Pre- and postoperative clear images were obtained. The color elevation model showed an increased projection and upper pole fullness after augmentation. The B-spline showed the gain in projection in a sagittal plane through the nipple. CONCLUSIONS: Three-dimensional TLS is capable of objectifying changes in shape after augmentation mammaplasty. This imaging technique represents superior visualization of the breast shape and can serve as a valuable tool to determine the changing dimensions of the breasts after augmentation mammaplasty.

Combined use of ultrasound-assisted liposuction and limited-incision platysmaplasty for treatment of the aging neck.

BACKGROUND: Many techniques have been introduced for the surgical treatment of the aging neck. In this study the combination therapy of ultrasound-assisted liposuction and limited-incision platysmaplasty for cervicofacial rejuvenation is presented. METHODS: Fifteen female patients (age = 43-75 years) were treated for grade II-III (n = 2), III (n = 6), and grade IV (n = 7) cervicomental angle deformity. The outcome of surgery was retrospectively evaluated by a panel. RESULTS: Ultrasonic energy was applied for an average of 2 min (range = 45 s-6.5 min). The mean aspiration volume was 125 ml. No immediate or delayed adjuvant skin reduction was needed in any of the patients. No complications were encountered in this series. After treatment significant improvement of the cervicomental angle was observed. CONCLUSION: For treatment of all grades of the aging neck we advocate the combination of UAL and limited-incision platysmaplasty. This combination therapy has little morbidity and leads uniformly to significant improvement of the cervicomental angle.

Use of 2-octyl-cyanoacrylate skin adhesive (Dermabond) for wound closure following reduction mammaplasty: a prospective, randomized intervention study.

BACKGROUND: 2-Octyl-cyanoacrylate skin adhesive may be used for surgical wound closure. However, its use in plastic surgery has not been properly assessed. METHODS: The authors conducted a prospective, randomized, controlled clinical intervention study in which the scar characteristics after use of skin adhesive were compared with those after suture closure. Bilateral reduction mammaplasty was performed in 50 patients. The method of closure (sutures versus skin adhesive) applied to each breast was determined randomly, using each patient as her own control. Scars were assessed by the patient and by a blinded panel, at 1 week, 6 weeks, and 6 months after surgery, using a visual analogue scale, the modified Hollander Wound Evaluation Scale, and the Patient and Observer Scar Assessment Scale. RESULTS: Both patients and panelists expressed an overall preference for the adhesive side as of 1 week after surgery. Patients' visual analogue scale scores for scar comfort and scar appearance and panelists' visual analogue scale scores for aesthetic outcome were significantly better for the adhesive side after 6 weeks and 6 months (p < 0.05), as was the total Hollander Wound Evaluation Scale score of the panelists after 6 weeks (p < 0.02). The total Patient and Observer Scar Assessment Scale score after 6 months was significantly better for the adhesive side according to the patients (p < 0.01), but not according to the panelists (p = 0.11). CONCLUSION: The authors conclude that 2-octyl-cyanoacrylate is a sound alternative for wound closure.

Anatomically shaped breast prosthesis in vivo: a change of dimension?

BACKGROUND: In addition to the already existing round cohesive gel-filled breast prostheses, anatomically shaped breast prostheses were introduced in 1990 to provide a more natural shape to the augmented or reconstructed breast. To date, however, it is unclear whether the anatomic configuration of the prostheses is maintained after subpectoral implantation. Recently, a three-dimensional (3D) magnetic resonance imaging (MRI) technique became available, offering a precise visualization of the prosthesis in vivo. Using this 3D MRI technique, this study aimed to compare the shape of commercially available round and anatomically shaped silicone gel-filled breast prostheses before and after implantation. METHODS: Using 3D MRI, 6 conventionally round and 12 symmetrically shaped silicone gel-filled prostheses were scanned in vitro. Scans were made in vivo 6 weeks after subpectoral implantation of these prostheses in nine patients. The in vivo 3D images were compared with the in vitro 3D images. RESULTS: Overall, a 3.5% decrease in projection was found on the in vivo images, as compared with the in vitro images. On the craniocaudally oriented images, a slight lateral shift of the cohesive gel was observed in the majority of the prostheses. Inamed Style 510 prostheses showed the best in vivo preservation of their configuration. CONCLUSIONS: The results show that both the round and the anatomically shaped silicone prostheses in vivo largely maintain their original in vitro configuration after subpectoral implantation.

Combined use of ultrasonic-assisted liposuction and semicircular periareolar incision for the treatment of gynecomastia.

BACKGROUND: Of the wide range of excisional and liposuction techniques used to correct gynecomastia, so far, no single one was suitable for all grades of gynecomastia. We introduce ultrasonic-assisted liposuction (UAL) combined with conventional liposuction and partial gland resection without skin excision as the standard surgical technique for all such grades. PATIENTS AND METHODS: Twenty-eight men (aged 17 to 80 years) were consecutively treated from March 2004 through April 2006 for grade Ia (n = 3), Ib (n = 2), IIa (n = 6), IIb (n = 6), III (n = 8), or IV (n = 3) gynecomastia. Their characteristics and the outcome of surgery were retrospectively assessed. RESULTS: A mean of 848 mL (range, 300 to 1400 mL) of liquefied breast tissue was aspirated, and 31 g (range, 3 to 180 g) of fibroglandular tissue were excised per breast. No immediate or delayed adjuvant skin reduction was needed in any of the patients. Moderate postoperative ecchymosis was observed in 2 patients, but no complications were encountered in this series. The cosmetic outcome was good to excellent in all. CONCLUSIONS: UAL in combination with gland resection through a minimal caudal semicircular periareolar incision and conventional liposuction effectively corrects all grades of gynecomastia. This combination has little morbidity, requires no skin excision, and leads to uniformly good esthetic results.