BACKGROUNDThe determination of the width of the implant is the first key step to select shape and volume of the implant in breast augmentation. The aim of this study was to introduce a new method to determine the width of the implant (W) and explain the reasons to do so in details.

METHODSFrom January 2006 to June 2014, the authors have found and applied "CD -4" theory to determine the width of breast implant (W) in dual plane I or II breast augmentation cases through transaxillary or periareolar incision for 560 patients. "CD" is defined as the curved distance on skin from the midline of the sternal bone to the anterior axillary line (AAL) on the lateral chest wall through the horizontal level on inferior mammary fold. W = CD - 4 (or 3.5) cm.

RESULTSThe 560 patients used both round and anatomic implants with W from 10.5 cm to 12.5 cm. Their CDs are from 14.5 cm to 17 cm. About 78% of the patients have got followed up from 1 month to 5 years postoperatively. Except for four patients who got unilateral capsular contractions, all the other patients are satisfied with their nature new breast shapes and volumes. Their new intermammary cleavages without bras are between 1 cm and 2.5 cm, and lateral borders of the breast are on the area of the AAL.

CONCLUSIONSW (width of the implant) = CD - 4 (cm) when doing dual plan I or II breast augmentation. For the very thin patient, 4 should be 3.5.

Breast Implantation ; methods ; Breast Implants ; Female ; Humans ; Mammaplasty ; methods

BACKGROUND: For the correction of small ptotic breasts, augmentation mastopexy provides a better shape than other techniques, but its periareolar or vertical scar is a limiting factor. Subglandular augmentation tends to increase ptosis. Submuscular augmentation may result in a "Waterfall" deformity (double contour deformity). This report uses examples of two patients to illustrate concepts for improving breast augmentation of ptotic breasts. METHODS: Two patients initially underwent insertion of breast implants for ptotic breasts, using full height type of implants inserted by the type III dual plane technique. Both patients had wanted breasts that were not excessively large, but which had an improved shape and minimal scars. At nearly the same time after the initial surgery (postoperative day 3 and 7), each patient exhibited a unilateral double contour breast deformity. The initial implants were changed to shorter height implants to shift volume to the lower pole. RESULTS: Changing the implants resulted in improved breast shape by enhancing the leverage effect. The double contour deformities observed after using the taller implants were improved by changing to shorter implants. CONCLUSIONS: For rotating the nipple areolar complex upward during correction of small ptotic breasts with implants, the type III dual plane technique is an effective way to produce a larger volume pocket in the lower pole of the breast. More leverage effect can be obtained by using a shorter height and greater projection type of shaped implant instead of a full height implant.
Breast Implantation ; Breast Implants ; Breast* ; Cicatrix ; Congenital Abnormalities ; Female ; Humans ; Mammaplasty ; Nipples* ; Postoperative Complications

OBJECTIVETo evaluate a breast augmentation technique for correction of minor and moderate breast ptosis with an anatomic implant.

METHODSFifteen patients of macromastia with minor and moderate breast ptosis were treated by using a breast augmentation with the anatomic implant under the breast gland. The results were judged with the the patient's satisfaction.

RESULTSAll of the patient achieved big improvement of the breast ptosis with very satisfactory results.

CONCLUSIONSThe minor and moderate breast ptosis could be achieved by using breast augmentation with an anatomic implant.

Adult ; Breast Diseases ; surgery ; Breast Implantation ; methods ; Breast Implants ; Female ; Humans

Implant-based breast reconstruction is the most common choice in breast cancer patients. Recently,the acellular dermal matrix (ADM) technique has been widely used in implant-based breast reconstruction in the western countries. This article briefly reviews the biological characteristics,history,types,surgical techniques,and postoperative complications of ADM.
Acellular Dermis ; Breast Implantation ; Breast Implants ; Breast Neoplasms ; surgery ; Female ; Humans ; Mastectomy ; Postoperative Complications

BACKGROUND: The use of anatomic implants has improved the aesthetic results of breast surgery; however, implant malrotation is an uncommon, but serious complication of these procedures. Nevertheless, little research has explored implant adhesion. In this study, we investigated adhesion between the expander and the capsule. METHODS: Seventy-nine cases of immediate breast reconstruction via two-stage implant-based reconstruction performed between September 2016 and November 2017 were evaluated. Mentor CPX4 expanders were used in 14 breasts, and Natrelle expanders in 65. We analyzed areas of adhesion on the surfaces of the tissue expanders when they were exchanged with permanent implants. We investigated whether adhesions occurred on the cephalic, caudal, anterior, and/or posterior surfaces of the expanders. RESULTS: Total adhesion occurred in 18 cases, non-adhesion in 15 cases, and partial adhesion in 46 cases. Of the non-adhesion cases, 80% (n=12) were with Mentor CPX4 expanders, while 94.4% (n=17) of the total adhesion cases were with Natrelle expanders. Of the partial adhesion cases, 90.7% involved the anterior-cephalic surface. The type of tissue expander showed a statistically significant relationship with the number of attachments in both univariate and multivariate logistic regression analyses (P<0.001) and with total drainage only in the univariate analysis (P=0.015). CONCLUSIONS: We sought to identify the location(s) of adhesion after tissue expander insertion. The texture of the implant was a significant predictor of the success of adhesion, and partial adhesion was common. The anterior-cephalic surface showed the highest adhesion rate. Nevertheless, partial adhesion suffices to prevent unwanted rotation of the expander.
Breast Implantation ; Breast Implants ; Breast ; Drainage ; Female ; Humans ; Logistic Models ; Mammaplasty ; Mentors ; Tissue Expansion Devices

We report the results of the clinical and histologic and radiologic findings of the 17 patients who visited our hospital for the removal of the breast implants. Their mean ages were 45.9 and they visited our hospital 11.4 years after their operation of the breast implantation. In the 8 cases of the 17 patients, the contractures were seen and masses were palpated in the 4 cases. We also could find 1 case of the infection and 1 case of the abscess. There were the cases of the granuloma, siliconoma, calcification too. We find the radiologic examination before the removal of the implants in the 11 cases and could find the finding of rupture at the 9 cases (14 implants) but we confirmed that the number of the ruptured implants were 7 postoperatively. We reinserted new implants in the 12 cases and used saline filled textured implants. the number of the patients who want to remove the silicone gel implants is increasing with the reports of the doubt on the safety of the silicone gel. But there were on clear evidences of harmful effects of the silicone gel at now. We have to study more and need more experiences to used the more exact information to the patients.
Abscess ; Breast Implantation ; Breast Implants ; Breast* ; Contracture ; Granuloma ; Humans ; Rupture ; Silicone Gels*

BACKGROUND: Most patients who desire breast augmentation have higher expectations than the outcomes that can be achieved. The purpose of this article is to propose strategies for coping with each patient's expectation, and selecting the most appropriate surgical method. METHODS: Data were retrospectively reviewed for 138 women who underwent breast augmentation between July 1, 2012 and June 30, 2014. The augmentation methods were selected based on the patients' expectations. According to each expectation, we recommended the optimal procedure and material for each patient, and performed the augmentation in accordance with this as much as possible. The patients were asked postoperatively whether they were satisfied with their outcomes. RESULTS: Most patients (85%) were satisfied with their results during the mean postoperative follow-up period of 21.4 +/- 7.6 months (range, 8-32 months). The remaining, dissatisfied patients (15%) accepted their final results after receiving explanations or additional procedures. CONCLUSIONS: We classified common expectations of breast augmentation patients into nine categories. To minimize the gap between expectations and outcomes, we preoperatively provided realistic explanations about the limitations of the chosen materials and surgical methods with each patient. We then performed breast augmentation in consideration of the patient's expectations. Consequently, we were able to appropriately deal with each patient's expectations.
Breast Implantation ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Patient Satisfaction ; Retrospective Studies

OBJECTIVETo investigate the feasibility of transaxillary dual-plane breast augmentation with endoscope assistant.

METHODSThe submuscular pockets were separated through a 4 cm transverse incision in the axilla. The pectoralis major muscle were split from the costal margin with the help of a 10 mm, 30 degree endoscope and endoscopic diathermy scissors. Soft cohesive gel microtextured anatomic style silicone implants ranging in size from 185 to 315 g were placed through the axillary incision. The vacuum drainage was used for 3 approximately 5 days.

RESULTS79 patients underwent the dual-plane breast augmentation. Postoperative analgesia requirements were reduced because of muscle strength releasing. The follow-up period was 4 to 6 months with satisfactory results. All the patients had aesthetically natural appearance, with the nipple at the most projected part of the breast. No rippling, lateral displacement, double-bubble deformity, or muscle contraction-associated deformities were seen. There was no complications such as capsular contracture, hematoma, hypertrophic scar, and infection.

CONCLUSIONSDual-plane breast augmentation using textured silicon gel implant can be completed with the endoscope assistance through the axillary incision. The technique combined retromammary and partial retropectoral pocket locations to optimize the benefits of each pocket location while avoiding the drawbacks of extra incision on the breast.

Adult ; Axilla ; surgery ; Breast Implantation ; methods ; Breast Implants ; Endoscopes ; Female ; Humans

OBJECTIVETo determine if miniprostheses would form a capsule of significantly different biophysical, biochemical and histologic properties than the conventional silicone implant.

METHODSFour miniprostheses (experimental group) and one big silicone implants (control 1 group) were separately implanted beneath the panniculus carnosus muscle of 30 rabbits. After 3 months, measures related to contracture and capsular histology were performed on anesthetized animals.

RESULTSBaker ranking, capsular incision width and capsular thickness of the control groups were evidently higher than that of experimental groups (P < 0.01). Implant compression of the control groups was evidently lower than that of the experimental group. Histology revealed a thinner, more flexed capsule around the miniprostheses as compared with big silicone implants.

CONCLUSIONSThe miniprostheses form a looser and thinner capsule than the conventional silicone implant.

Animals ; Breast Implantation ; adverse effects ; Breast Implants ; adverse effects ; Contracture ; pathology ; Female ; Postoperative Complications ; pathology ; Rabbits

BACKGROUND: Rupture is an important complication of breast implants. Before cohesive gel silicone implants, rupture rates of both saline and silicone breast implants were over 10%. Through an analysis of ruptured implants, we can determine the various factors related to ruptured implants. METHODS: We performed a retrospective review of 72 implants that were removed for implant rupture between 2005 and 2014 at a single institution. The following data were collected: type of implants (saline or silicone), duration of implantation, type of implant shell, degree of capsular contracture, associated symptoms, cause of rupture, diagnostic tools, and management. RESULTS: Forty-five Saline implants and 27 silicone implants were used. Rupture was diagnosed at a mean of 5.6 and 12 years after insertion of saline and silicone implants, respectively. There was no association between shell type and risk of rupture. Spontaneous was the most common reason for the rupture. Rupture management was implant change (39 case), microfat graft (2 case), removal only (14 case), and follow-up loss (17 case). CONCLUSIONS: Saline implants have a shorter average duration of rupture, but diagnosis is easier and safer, leading to fewer complications. Previous-generation silicone implants required frequent follow-up observation, and it is recommended that they be changed to a cohesive gel implant before hidden rupture occurs.
Breast Implantation ; Breast Implants* ; Contracture ; Diagnosis ; Follow-Up Studies ; Retrospective Studies* ; Rupture ; Silicone Gels ; Transplants