breast augmentation board

Question 1

What is the purpose of increased cross-linking of the silicone elastomer and internal barrier coating in the new, third-generation silicone gel prosthesis?

Answer 1

Increased cross-linking strengthens and thickens the wall of the implant. The inner barrier on the elastomer shell was designed to reduce silicone bleeding by inhibiting diffusion of the silicone through it

Question 2

What are the disadvantages of an augmentation performed in the subglandular plane as compared with subpectoral? What are the advantages?

Answer 2

Disadvantages: higher rate of capsular contracture, less satisfactory for mammography, and a higher risk of visibility, palpability, and a sharp transition in the upper pole.
Advantages: the subglandular plane allows increased control of inframammary fold position and shape and has little or no implant distortion with pectoralis contraction

Question 3

What are the disadvantages of an augmentation performed in the subpectoral plane as compared with subglandular?

Answer 3

Inferior lower-pole shape and inframammary fold definition. Also, late superior migration of the implants or pseudoptosis of the breast is possible

Question 4

In which patients should subpectoral implantation be used with caution? Why?

Answer 4

Patients with significant postpartum atrophy, glandular ptosis, and significant native tissue volume. Higher risk of
double-bubble deformity

Question 5

What is the significance of the “pinch test” for subglandular augmentation?

Answer 5

A minimum pinch test of 2 cm is recommended in the superior pole for adequate soft tissue thickness to cover a subglandular implant. Soft-tissue thickness less than 2 cm increases risk of rippling and wrinkling with subglandular placement and thus, submuscular placement is recommended

Question 6

What is a “dual plane” augmentation?

Answer 6

A variation of the subpectoral augmentation designed to reduce the risk of double-bubble deformity. Subpectoral dissection is combined with a partial subglandular dissection that extends a variable distance above the inferior border of the pectoralis major muscle

Question 7

What is the most common complication of breast augmentation?

Answer 7

Capsular contracture, with rates reported between 0.5% and 30%

Question 8

Describe the four Baker grades of capsular contracture.

Answer 8

Grade I: normal breast with no palpable capsule.
Grade II: minimal contracture with palpable, but not visible, implant.
Grade III: moderate contracture with easily palpable implant and visible implant or distortion.
Grade IV: severe contracture with breast that is hard, tender, painful, and cool, with marked distortion

Question 9

What should the implant pocket be irrigated with to decrease the incidence of infection and capsular contracture?

Answer 9

Mixture of 50,000 U Bacitracin, 1 g cefazolin, 80 mg gentamicin, and 500 mL saline

Question 10

What is the rate of grade III/IV capsular contracture for primary breast augmentation with silicone implants at 6-year follow-up (Mentor, Inamed)? Rate for revision augmentation?

Answer 10

Mentor and Inamed published their 6-year data for gel implants and show contracture rates (grade III/IV) of 20% to 28% after primary augmentation and 34% to 40% after revision augmentation

Question 11

What is the capsular contracture rate (grade III/IV) for saline implants at 13-year follow-up?

Answer 11

Approximately 21%

Question 12

What is the main advantage of textured implants?

Answer 12

Implant-surface texturing reduces the contracture rate for subglandular prostheses

Question 13

Compare contracture, leakage, and wrinkling rates between saline and silicone implants and what is the primary advantage of silicone implants?

Answer 13

Both implants produce contractures, wrinkling, and leakage at similar rates. Rupture is easier to detect in saline implants

Question 14

Which patients have a greater risk of excessive upper-pole fullness and distortion?

Answer 14

Thin patients, patients with a high inframammary crease, patients with a vertically or horizontally deficient chest,
and ptotic patients

Question 15

What factors should be evaluated prior to performing an augmentation that can help to choose the proper implant size, reduce the reoperation rate, and produce a more predictable outcome?

Answer 15

Base width (BW), nipple to IMF distance (N:IMF), soft tissue pinch thickness of the upper pole, and the anterior pull skin stretch

Question 16

What are the common locations for incisions for placing breast implants?

Answer 16

Periareolar, inframammary, transaxillary, and periumbilical incisions.

Question 17

In which patients should the periareolar incision be used with caution?

Answer 17

Patients with small areolar diameters (<3 cm), and patients with areolas that are lightly colored with indistinct
margins

Question 18

In which patients should the inframammary incision be used with caution?

Answer 18

Patients with poorly defined inframammary folds, constricted breasts, or an inframammary fold too close to the
areola

Question 19

Where are the disadvantages of a transaxillary approach?

Answer 19

Less control and accuracy as compared with a more direct approach, theoretically increasing the risk of implant
malposition or asymmetry. Difficult or impossible with silicone implants

Question 20

In which patients should the transaxillary approach not be used?

Answer 20

Patients with tuberous breast deformity, patients requiring parenchymal rearrangement, or patients in whom an
anatomic or large silicone implant has been chosen

Question 21

What are the long-term changes seen in the breast tissue and chest wall in an augmented patient?

Answer 21

Breast parenchymal atrophy and costal cartilage remodeling that results in a concave shape of the ribs. All implants,
especially larger implants, will cause shrinkage and thinning of breast tissue

Question 22

What is the advantage of mastopexy with augmentation versus mastopexy alone in patients with grade 2 ptosis?

Answer 22

Implants can enhance the size and contour of the breast and most importantly increase upper pole fullness

Question 23

What is the reported infection rate after augmentation?

Answer 23

1% to 2.2%

Question 24

What is the most common aerobic pathogen?

Answer 24

Staphylococcus aureus and Propionibacterium acnes

Question 25

What is the treatment of infection after implant placement?

Answer 25

For superficial infections not involving the periprosthetic space, oral or intravenous antibiotics without drainage of the pocket can be used. For more severe infections involving the implant pocket, management includes implant removal, irrigation, capsule debridement, antibiotics, and reinsertion of the implant several months later

Question 26

On average, what is the reported rate of decreased nipple sensation?

Answer 26

15%, regardless of incision type

Question 27

What is the rupture rate of saline-filled implants per year?

Answer 27

1% per year

Question 28

What is the reoperation rate for silicone implant-related complications during the first 6 years after primary
augmentation? After revision augmentation?

Answer 28

Approximately 20% to 25% after primary augmentation and 35% for revision augmentation

Question 29

What factor increases the risk of rupture of saline-filled implants?

Answer 29

Underfilling the implant resulting in an implant fold abnormality.

Question 30

What is the most accurate imaging modality for evaluating implant integrity?

Answer 30

MRI

Question 31

According to the US FDA, what is the recommended schedule of MRI screening to detect silicone prosthesis rupture?

Answer 31

Three years after surgery and then every two years

Question 32

What are the key characteristics of tuberous breast deformity?

Answer 32

Herniation of the breast tissue into the nipple–areola complex with a cylindrical projection accompanied by a
relatively large areola, deficiency of the lower pole of the breast in both vertical and horizontal axes, and hypoplasia

Question 33

What is the primary treatment and augmentation incision type for tuberous breast deformity?

Answer 33

Periareolar mastopexy with augmentation, radial-releasing incisions to allow expansion of the base of the breast, and
areolar reduction

Question 34

What is synmastia and what are the risk factors for synmastia after breast augmentation?

Answer 34

Synmastia is defined as when the breast implant crosses the midline, even if it is only on one side. Risk factors include use of large prostheses with large base diameters, multiple successive enlargement procedures, preexisting chest wall deformities, and subpectoral implant positioning