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
What is the most common complication with breast augmentation?
Capsule contracture, 0.5%-30%
What should the implant pocket be irrigated with to decrease infection and contracture?
50,000 U bacitracin, 1g ancef, 80mg gentamicin, 500ml saline
What is the rate of capsular contracture with primary breast augmentation and revision augmentation?
20-28% for primary
34-40% with revision
Compare contracture, leakage, wrinkling rates between saline and silicone implants. What is the advantage of saline implants?
Same. Leaks/ruptures are easier to detect with saline.
What factors should be evaluated prior to performing an augmentation?
Base width (BW), nipple to IMF distance, soft tissue pinch, anterior skin pull stretch
In which patients should peri-areolar incisions be used with caution?
Small areolas <3cm, light colored areolae with indistinct borders
In which patients should inframammary incisions be used with caution?
Poorly defined IMF, constricted breasts, or IMF too close to the areola
What are the disadvantages of transaxillary approach?
Less control and accuracy, Difficult/impossible with silicone implants, Can injury intercostobrachial or medial brachial cutaneous nerves
In which patients should transaxillary approach NOT be used?
Patients with tuberous breasts, patients who require parenchymal rearrangement, anatomic or large implants
What are the long term changes seen in the breast tissue and chest wall in an augmented patient?
Breast parenchymal atrophy, costal cartilage remodeling
What is the reported infection rate with augmentation?.
1-2.2%
What is the most common aerobic pathogen? Anaerobic?
Staph epidermidis; Propionibacterium acnes
What is the treatment of infection after implant placement?
Superficial: oral or IV antibiotics without drainage
Severe (involving pocket): implant removal, irrigation, capsule debridement, antibiotics, reinsertion of the implant several months later
On average, what is the reported rate of decreased nipple sensation?
15% regardless of incision
What is the rupture rate for saline implants per year?
1%
What is the reoperation rate for silicone implant-related complications during the first 6 years after primary and revision augmentation?
Primary: 20-25%
Revision: 35%
What factor increases the risk of rupture for saline implants?
Underfilling leading to implant fold abnormality
What is the most accurate imaging modality for evaluating implant integrity?
MRI (Liguini sign indicates intracapsular silicone implant rupture)
According to the US FDA what is the recommended schedule of MRI screening to detect silicone prosthesis rupture?
3 years after surgery and every 2 years
What are the key characteristics of tuberous breast deformity?
Herniation of the breast tissue into the NAC, cylindrical projection with relatively large areolae, deficiency of lower pole breast tissue in both horizontal and vertical axis, hypoplasia, constricted and high IMF
What is the primary treatment and augmentation incision type for tuberous breasts?
Periareolar mastopexy with augmentation, radial-releasing incisions to allow expansion of the base of the breast, areolar reduction and lowering iMF
What is symmastia and what are the risk factors for developing it during breast augmentation?
When the breast implant crosses the midline, even if only on one side. Risk factors include large implants with large bases, multiple successive enlargement procedures, pre-existing chest wall deformities, subpectoral implant positioning
