Breast Augmentation/Breast Implant Efficacy and Safety - Board Review Flashcards
What are the findings on mammogram after fat transfer breast augmentation? Are these findings more or less common than breast reduction patients?
Lipid cysts, diffusely scattered calcifications, sometimes can appear more like malignant findings (clustered branching calcifications and spiculated masses) - less common than found on breast reduction patients
What complication is more likely to occur with aug/masto in tuberous breast patient?
Double bubble if the native IMF is not properly released. May improve spontaneously.
What factors are linked to higher rate of reoperation in patients undergoing augmentation?
Pre-existing breast ptosis and simultaneous mastopexy (increasing grades of ptosis associated with higher reoperation rates)
What are the correlations with incision placement and rate of capsular contracture?
IMF incisions have the lowest rate, periareolar and transaxillary have 5-10x higher complications
What is the main factor that can contribute to adverse outcomes with simultaneous aug/mastopexy?
large prosthesis (>350ml) leads to greater adverse effects and soft-tissue attenuation
What is double capsule phenomenon and with what type of implants does it more commonly occur?
Late onset seroma without signs of infection. Capsule layer is seen lining the pocket and often contains serosang seroma fluid, a second tight pocket is found around the implant. Usually textured implants.
What is the most important factor in determining the maximum acceptable prosthesis size for a patient?
Breast base width
What is the main arterial supply to the breast gland and nipple during submuscular augmentation?
Thoracoacromial travels just deep to the pec major muscle. Subglandular dissection disrupts this blood supply.
What is the appropriate intervention for implants appearing “too high” soon after augmentation?
Breast massage and breast band application.
What is the most common complication after cohesive gel breast prosthesis?
Grade III/IV Capsular contracture (9.8% for aesthetics, 13.7% for recon at 6 years). Rupture 1.1%/3.8% and infection 1.6%/6.1%
What factors are associated with increased risk of rippling implants?
Textured implants, saline implants, subglandular placement, thin native breast tissue, ptosis
What are the disadvantages and disadvantages of an augmentation performed in the subglandular plane as compared with subpectoral?
Advantages: increased control of IMF, shape and no animation deformity
Disadvantages: higher rate of capsular contracture, less satisfactory for mammography, higher risk of visibility, palpability, sharp transition in upper pole
Which patients should subpectoral implantation be used with caution and why?
Patient with significant postpartum atrophy, glandular ptosis, significant native volume loss; higher risk of double bubble deformity
What is the significance of the “pinch test”?
Minimum 2cm pinch in superior pole for adequate soft-tissue thickness to cover subglandular implant
What is dual plane augmentation?
Subpectoral dissection combined with subglandular dissection that extends a variable distance above the inferior border of the pectoralis major muscle. Used to reduce the risk of double bubble