Augmentation Mammoplasty, Mastopexy, and Mastopexy-Augmentation Flashcards
the primary goal of breast augmentation
the primary goal to increase the size ofthe breast
Mastopexy-augmentation can be performed as a single-stage procedure to alter both the size and shape of the
breast
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The main goal of BA is to increase the volume ofthe breast and centralize the nipple on the breast mound
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The chest wall is the foundation
upon which a prosthetic device will sit
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Standard
measurements before BA
base width (BW),
sternal notch to nipple distance (SN-N),
nipple to the inframammary fold (N-IMF),
NAC diameter, and internipple distance
The BW is a key measure for determining the appropriate transverse
dimension ofa breast implant and chest wall diameter
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2 cm of pinch thickness is considered the minimum necessary for placement of an implant in the subglandular or subfacial
plane
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The
interface between the skin and the breast parenchyma should also
be evaluated why?
as postpartum women or patients with poor dermis
due to massive weight loss may have skin that very easily glides over
the underlying breast parenchyma.
The lower pole of the breast can
be constricted in patients with micromastia or mild tuberous breast
deformity
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In case of lower pole constriction what you will do to treat the like this patients?
Lowering of the IMF and recruitment of upper abdominal
skin may be warranted in these patients and should be considered
during the evaluation.
An assessment of the width of the sternum is
important why?
That can help the surgeon talk to a patient about expected
superomedial fullness and interbreast distance that will likely persist
after augmentation
the width of sternal can be decreased by placing the implant submuscular
F This distance can be decreased and even lead
to symmastia when the implant is placed subglandularly, but is less
likely with submuscular placement because the medial pectoralis
muscle attachments are left intact and prevent medial migration.
BA can lead to increase the risk for Breast cancer
F Women with augmented breasts are at no
increased risk of breast cancer compared to women with nonaugmented breasts.
Women with breast implant can not make mamogram screening
F Women with
a history of breast augmentation undergo screening mammography
with special implant-displaced or Eklund views to better assess the
tissue anterior to the implant
The sensitivity is increased with ultrasound (US) or magnetic resonance imaging (MRI) compare with mamogram alone
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(FDA) recommended screening with MRI
for silent ruptures 3 years after placement and then every 2 years
thereafter
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Mamogram mandatory for women seeking BA
F For women desiring breast augmentation, routine mammographic screening should be performed or reviewed if indicated
preoperatively using the US Preventative Services Task Force guidelines based on age over 40 and risk
Patients who seek
BA who have no visible breast skin below the NAC on a frontal view
(grade II ptosis)
F Patients who seek
BA who have no visible breast skin below the NAC on a frontal view
(grade III ptosis) likely need a mastopexy as well to reposition the
NAC on the breast mound
patients who have visible breast skin below the NAC (pseudoptosis or grade I and II ptosis)
on a frontal view may be candidates for BA alone
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patientwith an IMF at the junction ofthe middle and distal thirds ofthe
humerus may be considered “high” breasted
F patientwith an IMF at the junction ofthe middle and distal thirds ofthe
humerus may be considered “low” breasted
IMF at the middle of the humerus may be considered “high” breasted
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The pectoralis major’s inferior attachments can be above or below the NAC and at
or above the IMF.
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Why the location pf pectoralis major muscle important relative to the NAC ?
For example,
a low breasted patient with a pectoralis major muscle attachment that
is higher than the NAC may not benefit from subpectoral placement
of the breast because the implant will ride high behind the pectoral
muscle whereas the NAC will remain in a lower position and not be
centered on the implant and augmented breast mound
Silicone implants are considered “off label” when
used in women less than 18 years old per the FDA
F Silicone implants are considered “off label” when
used in women less than 22 years old per the FDA
A major difference besides cost and feel is that saline and silicone
implants differ in how a device rupture is detected
T
First and
second generation silicone ruptures led to free floating silicone in the
pocket leading to inflammation and silicone granuloma formation
T
Ruptures of the current fifth-generation implants are just like the first and second generation rapture
F Ruptures of the current fifth generation implants are very different.
Silicone ruptures with cohesive gel implants can be detected on mammogram but more often require MRI to confirm a suspected rupture.
Often delayed capsular contracture can be due to a silent rupture ofa
highly cohesive gel implant
For a round device,
height and width will be the same
T for a given base width
with a round device, an implant can vary in volume and projection
it is not possible to accurately detect a shaped versus round implant in the submuscular plan
intraoperatively
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Round implant has a more round superomedial curve whereas an
anatomic implant has a more teardrop look when placed in the submascular
f round implant has a more round superomedial curve whereas an
anatomic implant has a more teardrop look when placed in the subglandular or subfascial plan
Which factors play a role in soft tissue integration with the breast implant surface
Surface area, pore size, and distribution may
play a role in soft tissue integration with the breast implant surface,
the organization of myofibroblasts and matrix proteins, and potential for accumulation of bacterial biofilms
Textured devices have lower rates
of capsular contracture, or the formation of a capsule that leads to
deformity and/or pain in the breast following BA
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Textured devices are thought to be less likely to migrate
beyond the dissected pocket
F anatomic, textured devices have demonstrated that even these implants can have rotation and malposition necessitating reoperation
anatomic implants are all textured devices. Round devices can come as
either textured or smooth.
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The subglandular plane used by the breast surgeons
when they perform mastectomies
F The subfascial plane is below the fascia of the pectoralis muscle and above
the muscle itself
retropectoral pocket
Submascular plane
Dual-plane breast augmentations, as
graded I, II, and Ill, vary by the amount of pectoralis muscle release
inferiorly and subsequent amount of contact between the implant
and breast parenchyma inferiorly.
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The IMF incision is placed in the original IMF crease
The IMF incision is placed in the desired IMF crease,
which may be below the native IMF if the IMF is going to be lowered in a BA
Transaxillary incisions are made in the
hair-bearing region of the axilla
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Delayed seromas with or without an associated mass should raise suspicion for breast implant-associated anaplastic large cell lymphoma
(BIA-ALCL)
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A MRI is recommended to visualize a suspicious seroma or mass
F A PET-CT scan is recommended to visualize a suspicious seroma or mass
Treatment of BIA-ALCL always requires complete capsulectomy, and depending on the stage of disease, it may also need adjuvant
chemotherapy or immunotherapy
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complications after
BA
1 % to 2% for hematoma
1 % for infection and deep vein thrombosis/pulmonary embolism (DVT/PE)
Capsular contracture rates from long-term studies
demonstrate variability based on implant manufacturer
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The Baker classification system of capsular contracture depend on what ?
It relies on physical examination to assess how soft
the augmented breast and whether or not the patient reports pain
