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      Dual Pedicle Mastopexy Technique for Reorientation of Volume and Shape After Subglandular and Submuscular Breast Implant Removal

      research-article
      , MD, PhD, FACS, , MD, , PA-C
      Eplasty
      Open Science Company, LLC
      breast implant, capsule formation, dermaglandular pedicle, implant removal

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          Abstract

          Background: The purpose of this article was to report our experience in achieving satisfactory breast shape and volume using dual pedicle mastopexy technique after subglandular and submuscular breast implant removal. Methods: Breast implant-related problems in 51 breasts included capsular contracture (Baker grade III-IV), 76%; implant rupture/bleed, 41%; breasts undergoing repeat surgery more than once, 22%. The size of the breast implants removed ranged from 240 to 525 cc (average size: 320 ± 65 cc) (saline-filled, 40%; silicone-filled, 60%; subglandular, 40%; submuscular, 60%). Capsulectomy, implant removal, and dual pedicle mastopexy were performed for reconfiguration of breast shape and reorientation of volume. Results: Mean follow-up was 14.5 months. On average, 65.0% of breast implant volume was achieved. There was 1-cup reduction in brassiere size in 21 patients, and the cup size remained the same in 5 patients. Postoperative pain scores were no pain or mild pain in 26 patients who initially in the preoperative evaluation reported having mild pain (11), moderate pain (12), and severe pain (3). Overall patient satisfaction scores were 3 (neutral) in 1 patient, 4 (satisfied) in 12 patients, and 5 (very satisfied) in 13 patients. Conclusion: The dual pedicle mastopexytechnique provided a reliable way of reorienting breast volume and configuring breast shape in patients who opted to have implants removed without replacement. The results demonstrated that a pleasing outcome could be obtained using the described technique with additional benefits of elimination of breast tenderness and discomfort secondary to implant removal and/or capsulectomy.

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          Most cited references22

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          A long-term study of outcomes, complications, and patient satisfaction with breast implants.

          Breast implants have been used worldwide for more than 40 years. Despite extensive clinical experience, there is continued concern about the safety of these devices. The purpose of this study was to compare the efficacy, complication rates, frequency of reoperation, and degree of patient satisfaction with different types of implants. This is a consecutive, population-based study consisting of all patients receiving implants at a multidisciplinary breast center between 1979 and 2004 (25 years). A prospective implant database was constructed and maintained in Excel, and statistical analysis was performed using SAS 8.2. Various outcomes, including infections, hematomas, undesirable waviness, capsular contracture, deflation, rupture, reoperation, and patient satisfaction, were monitored. Data were collected on 3495 implants in 1529 women. The longer implants were in place, the greater the cumulative risk of developing contracture; hematoma significantly increased the risk of contracture; smooth and textured implants had similar contracture rates; polyurethane foam-covered implants had a reduced risk of contracture persisting for at least 10 years after implantation. There was a relatively high rate of reoperation and a relatively short interval between primary surgery and reoperation; the most common indication for reoperation was capsular contracture. Implant recipients expressed a high overall level of satisfaction. Breast implants are associated with a significant rate of local complications and reoperation. There are marked differences in outcomes as a function of implant surface type and surgical indication. Despite relatively frequent complications and reoperations, implant recipients are largely satisfied.
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            Classification of capsular contracture after prosthetic breast reconstruction.

            The Baker classification of capsular contracture remains the most popular and practical method of assessing clinical firmness of the breast after augmentation mammaplasty. This classification system was never intended to describe prosthetic breast reconstruction. A modification of the Baker classification to include classes IA, IB, II, III, and IV has been developed to describe breast reconstruction more accurately. For this modified system, a soft but visible implant (class IB), an implant with mild firmness (class II), and an implant with moderate firmness (class III) could still be considered good or excellent outcomes. Only a class IV classification with an excessively firm and symptomatic breast resulting in a poor aesthetic result would necessarily be considered a poor outcome.
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              Bacterial biofilms and capsular contracture in patients with breast implants.

              It has been hypothesized that bacterial biofilms on breast implants may cause chronic inflammation leading to capsular contracture. The association between bacterial biofilms of removed implants and capsular contracture was investigated. Breast implants explanted between 2006 and 2010 at five participating centres for plastic and reconstructive surgery were investigated by sonication. Bacterial cultures derived from sonication were correlated with patient, surgical and implant characteristics, and the degree of capsular contracture. The study included 121 breast implants from 84 patients, of which 119 originated from women and two from men undergoing gender reassignment. Some 50 breast prostheses were implanted for reconstruction, 48 for aesthetic reasons and 23 implants were used as temporary expander devices. The median indwelling time was 4·0 (range 0·1-32) years for permanent implants and 3 (range 1-6) months for temporary devices. Excluding nine implants with clinical signs of infection, sonication cultures were positive in 40 (45 per cent) of 89 permanent implants and in 12 (52 per cent) of 23 temporary devices. Analysis of permanent implants showed that a positive bacterial culture after sonication correlated with the degree of capsular contracture: Baker I, two of 11 implants; Baker II, two of ten; Baker III, nine of 23; and Baker IV, 27 of 45 (P < 0·001). The most frequent organisms were Propionibacterium acnes (25 implants) and coagulase-negative staphylococci (21). Sonication cultures correlated with the degree of capsular contracture, indicating the potential causative role of bacterial biofilms in the pathogenesis of capsular contracture. NCT01138891 (http://www.clinicaltrials.gov). © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.
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                Author and article information

                Journal
                Eplasty
                Eplasty
                ePlasty
                Eplasty
                Open Science Company, LLC
                1937-5719
                2013
                16 September 2013
                : 13
                : e48
                Affiliations
                [1]Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver
                Author notes

                Author Contribution: Raffi Gurunluoglu, MD: Performance of all cases, the conception and design of the article, analysis and interpretation of data, drafting the article, final approval of the version to be submitted.

                Edward Kubek, MD: Assistance in the operating room for all cases, revision of the article critically for important intellectual content.

                Jamie Arton, PA-C: Acquisition, analysis, and interpretation of data, drafting the article.

                Disclosure: None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this article.

                Article
                48
                3776568
                24058719
                7babb737-a7eb-41a7-8e48-bb934d43f0cf
                Copyright © 2013 The Author(s)

                This is an open-access article whereby the authors retain copyright of the work. The article is distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Journal Article

                Surgery
                breast implant,capsule formation,dermaglandular pedicle,implant removal
                Surgery
                breast implant, capsule formation, dermaglandular pedicle, implant removal

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