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Breast > Breast augmentation > Flashcards

Breast augmentation Flashcards

1
Q

List 4 features of the ideal breast

A

1) upper pole : lower pole volume distribution ~ 45:55 2) Nipple angulation ~ 20’ up 3) Straight or slightly concave upper pole 4) Tight convex lower pole

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2
Q

Define biofilm

A

a structured community of micro-organisms encapsulated within a self-develop polymeric matrix that is irreversibly adherent to surface of indwelling foreign body

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3
Q

List mechanisms to reduce risk of capsular contracture

A

1) prophylactic antibiotics 2) nipple shield 3) IMF approach 4) submuscular position 5) textured implant for subglandular position 6) prophylactic hemostasis 7) pocket irrigation with triple mix (cephazolin, bacitracin, gentamycin) 8) implant irrigation with bacitracin 9) chest wall betadine prep 10) glove change 11) no touch (funnel) or single-touch technique

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4
Q

What is the difference between silicon and silicone

A

silicon: elemental silica , SiO2 silicone : polymer of dimethyl siloxane (CH4)2- Si- O2

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5
Q

What are contraidications to Breast augmentation

A
  • immunosuppression
  • active infection
  • medically unfit
  • undiagnossed breast pathology
  • unreasoble expectations or inabilit to comprehend possible complications
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6
Q

What are key points to obtain on history and physical

A

HISTORY

  • Breast Hx - RF, FamHx, Personal Hx, last mammogram
  • Pregnancy Hx
  • Satisfaction with curent breast size and shape
  • Patient goals, motives expectations
  • PMHx
  • SocHx
  • Occupational Hx
  • MEds, All

PHYSICAL EXAM

  • height weight bra cp size
  • Breast SSS (size shape symmetry)
  • Ptosis
  • IMF NAC
  • Masses
  • Envelope thickness
  • MEasureemnts: Sn-N, N-M, BW, N-IMF, IMD, STPT UP, IMF, APSS
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7
Q

What are techqnieus for autologous fat transfer to the breast

A
  • Pre-expansion
    • negative pressure suctio apparatus to expand volume and increase volume of fat retained
  • Direct autologous transfer
    • may require multiple stages of fat transfer
  • Fat harvest
    • PAL, manual, SAL
  • Fat processing
    • gravity via decanter, low pressure, high pressure centrifuge
  • Adjuncts
    • PRP, implant
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8
Q

What are features of an ideal breast implant

A
  • Non-allergenic
  • Non-carcinogenic
  • Non-irritant
  • Inert material
  • Impervious to body fluids
  • producable in desired form
  • sterilizable
  • natural feel
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9
Q

How do you classify breast implants

A
  • SHELL MATERIAL
    • Silicone rubber (dimethylsiloxane)
  • SHELL SURFACE
    • Smooth
    • Textured
      • Mentor (Siltex) - irregular depressions due to lost salt technique
      • Allergan (Biocell) - regular depressions due to negative imprint of impression
  • FILLER MATERIAL
    • Cohesive gel
      • Mentor Memory Gel Cohesive I, II, III
      • Allergan TruForm I (Responsive), II (Soft Touch), III (cohesive)
    • Saline
  • SHAPE
    • Round
      • Mentor, T/S
      • Allergan (Natrlle inspira) T/S, 4 projections
    • Anatomic
      • Mentor CPG saline or silicone 300series
        • 3XY (3 = most cohesive, X=height, Y projection)
      • Allergan 410 soft touch (2) and cohesive(3)
        • 410XY (X-height, Y-projection)
      • Allergan 510 - cohesive gela t base and Firm cohesive gel anterior (to maintian projection for tuberous/poland, ptosis)
  • STRUCTURE (LUMEN)
    • single lumen
    • double lumen
      • Becker Mentor - silicone outside, saline inside
  • GENERATION
    • 1st (60s) Thich shell, gel, dacron patch, anatomic => high CC#
    • 2nd (70s) Thin shell, gel less viscious, round =>high rupture #
    • 3rd (80s) Thick Trilayer S/T, thicker gel, round, low bleed
    • 4th (90s) Thick shell S/T thicker gel, round, low bleed
    • 5th (90s) same as 4th but enhanced coheisve form stable gel for anatomic
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10
Q

What is a capsular contrature

A

contraction of bursa cavity around implant creatinga tight cavity

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11
Q

What are the three layer of a implant capsule

(Pasyk indicated 4 layers of capsule around tissue expander)

A
  • Outer: vascular, loose connective tissue
  • Middle: acellular, collagen fibersi nparallel bundles
  • Inner: myofibroblasts, fibrocystes, histiocytes with collagen

PASYK

  • inner layer: synovial-like layer with fibrin and macrophages
  • central layer: elongated fibroblasts and myofibroblasts
  • transition zone: loose areolar connective tissue (loose collagen)
  • Outer zone: vascular layer, blood vessels and parallel collagen
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12
Q

What is the etiology of CC

A
  • Infectious origin
    • subclinical infection
  • Hypertrophic scarring
    • 2’ to hematoma, seroma, silicone bleed
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13
Q

What factors influence CC

A
  • Implant: textured vs smooth
  • Operative technique
    • antibiotic pocket irrigation
    • no touch or talc-free gloves
    • pocket size relative to implant
    • closed system for saline fill
    • intraluminal steroid
  • Post-op
    • massage
    • oral vitamin E
  • Patient
    • Hx of radiation
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14
Q

What is the treatment of CC

A
  • Open capsulotomy
  • Open capsulectomy
  • change of implant location (subglandular, subpectoral, dual plane)
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15
Q

What are uses for ADM in revision breast surgery?

A
  • Correction of malposition
  • Reinforce envelope - rippling with thin tissue
  • Reinforce following casulectomy - CC
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16
Q

How do breast implants affect detecttion and treatment of breast cancer

A
  • No increased incidence of BrCa
  • No delay in diagnosis, prognosis
  • visualization of breast tissue is decreased with implantssubglandualr worst with CC3-4
  • Tx with open biopsy, no needle/core
  • Tx with ALND, not SLNBx If periA incision used
17
Q

What is the grading of CC

A

Baker classification

  • Grade 1 - soft capsule
  • Grade 2 - Capsule palpable as firm, not visible
  • Grade 3 - Capsule firm and visibly distorting
  • Grade 4 - Capsule firm, visible and painful
18
Q

What is ALCL

A

Anaplastic Large Cell Lymphoma

  • a rare Tcell CD30 + lyphoma
  • possible link between ALCL and breast implants
19
Q

How does ALCL present

A

>1yr post op with seroma

Mass

20
Q

What is the maangement of a pt presenting with peri-prosthetic fluid collection

A
  1. Rule-out infection
    1. bld/fluid cx, antibitics
  2. If no resolution, and no mass present
    1. Open evaluation (bx, capsulectomy) OR closed evaluation (PC drainge, fluid evaluation)
  3. If no resolution and mass present
    1. Surgical oncology for evaluation/management
  4. If no resolution following open/closed evaluation
    1. Recommend surgical exploration (removal implant, antibiotic rinse, capsulectomy, replace new implants
21
Q

What is the treatment for ALCL

A

based on alk status

Chemo + Rad

22
Q

What do you send the fluid and capsule for to diagnose ALCL

A

Capsule => Path to r/o ALCL

Fluid =>cytologic evaluation with giemsa stained smears and immunohistochemistry for CD30 and ALK (anaplastic lymphoma kinase

23
Q

What are the goals of augmentation mastopexy

A
  • improve breast shape and volume
  • correct NAC position
  • achieve symmetry
24
Q

What are indications for augmastopexy

A
  • Deflation and ptosis post-partum, weight loss, aging
  • loss of upper pole fullness
25
Q

What are contraindications for one stage Augmasto

A
  • need NAC elevation >6cm
  • smokers
26
Q

How do you classify ptosis?

A

Regnault

GRade 1 - NAC at IMF, above lower contour of gland

Grade 2 - NAC below IMF, above lower contour of gland

Grade 3 - NAC below IMF, at of below the lower contour of the gland

Pseudoptosis - NAC at normal position but gland below IMF

27
Q

What anatomical changes occur with ptosis

A

increased SN-N

No sig. change in N-IMF

lowered NAC

28
Q

What are options for performing an augmastopecy

A

INCISION

  • circumareaolar, crescnt
  • circumvertical
  • inveerted T

POCKET

  • dual plane
  • subglandular
  • submuscular

IMPLANT

  • round, LP,MP

STAGES

  • combined - 1stage
  • augmentation then mastopexy if required
  • mastopexy then augmentation if required
30
Q

What are the layers of the capsule surrounding a breast implant?

A
  1. Inner zone - synovial like layer with fibrin and macrophages
  2. Central zone - elongated fibroblasts and macrophages
  3. Transition zone - loose areolar connective tissue
  4. Out zone - blood vessels and collagen

Breast (6 decks)

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