breast augmentation board Flashcards
What is the purpose of increased cross-linking of the silicone elastomer and internal barrier coating in the new, third-generation silicone gel prosthesis?
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
What are the disadvantages of an augmentation performed in the subglandular plane as compared with subpectoral? What are the advantages?
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
What are the disadvantages of an augmentation performed in the subpectoral plane as compared with subglandular?
Inferior lower-pole shape and inframammary fold definition. Also, late superior migration of the implants or pseudoptosis of the breast is possible
In which patients should subpectoral implantation be used with caution? Why?
Patients with significant postpartum atrophy, glandular ptosis, and significant native tissue volume. Higher risk of
double-bubble deformity
What is the significance of the “pinch test” for subglandular augmentation?
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
What is a “dual plane” augmentation?
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
What is the most common complication of breast augmentation?
Capsular contracture, with rates reported between 0.5% and 30%
Describe the four Baker grades of capsular contracture.
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
What should the implant pocket be irrigated with to decrease the incidence of infection and capsular contracture?
Mixture of 50,000 U Bacitracin, 1 g cefazolin, 80 mg gentamicin, and 500 mL saline
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?
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
What is the capsular contracture rate (grade III/IV) for saline implants at 13-year follow-up?
Approximately 21%
What is the main advantage of textured implants?
Implant-surface texturing reduces the contracture rate for subglandular prostheses
Compare contracture, leakage, and wrinkling rates between saline and silicone implants and what is the primary advantage of silicone implants?
Both implants produce contractures, wrinkling, and leakage at similar rates. Rupture is easier to detect in saline implants
Which patients have a greater risk of excessive upper-pole fullness and distortion?
Thin patients, patients with a high inframammary crease, patients with a vertically or horizontally deficient chest,
and ptotic patients
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?
Base width (BW), nipple to IMF distance (N:IMF), soft tissue pinch thickness of the upper pole, and the anterior pull skin stretch
What are the common locations for incisions for placing breast implants?
Periareolar, inframammary, transaxillary, and periumbilical incisions.
In which patients should the periareolar incision be used with caution?
Patients with small areolar diameters (<3 cm), and patients with areolas that are lightly colored with indistinct
margins
In which patients should the inframammary incision be used with caution?
Patients with poorly defined inframammary folds, constricted breasts, or an inframammary fold too close to the
areola
Where are the disadvantages of a transaxillary approach?
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
In which patients should the transaxillary approach not be used?
Patients with tuberous breast deformity, patients requiring parenchymal rearrangement, or patients in whom an
anatomic or large silicone implant has been chosen
What are the long-term changes seen in the breast tissue and chest wall in an augmented patient?
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
What is the advantage of mastopexy with augmentation versus mastopexy alone in patients with grade 2 ptosis?
Implants can enhance the size and contour of the breast and most importantly increase upper pole fullness
What is the reported infection rate after augmentation?
1% to 2.2%
What is the most common aerobic pathogen?
Staphylococcus aureus and Propionibacterium acnes
