Augmentation mammaplasty: a comparative analysis

With the continuation of augmentation mammaplasty as a desirable operation for a large segment of the female population in the United States, the problem of fibrous capsular contracture that has been present since the inception of the operation has persisted. Various approaches to the problem have been entertained, and a lessening of the incidence has occurred as reviewed in our earlier report, which follows augmentation mammaplasty in our clinic from 1962 through 1979. In this retrospective study, no significant difference in contracture rate was seen based on patient smoking habits, operative approach used, or implant type. It is important to note that the total experience with the low-bleed implant was significantly lower in terms of number of patients meeting the criteria of this retrospective study than the standard gel mammary implant. Greater follow-up time and number of patients will be evaluated in future retrospective studies. We have demonstrated in this study that placement of the implant beneath the pectoral muscle has significantly diminished the incidence of capsular contracture both as Baker grades II, III, and IV and as Baker grades III and IV. The retropectoral site has become the preferred location for the prosthesis in our clinic. There is no appreciable alteration in the overall shape of the breasts from this approach, and therefore, it will continue to be the preferred method. Rates of incidence of hematoma, the most frequent adverse reaction after contracture, were not significantly different between the retropectoral and retromammary implant sites.(ABSTRACT TRUNCATED AT 250 WORDS)     

Augmentation mammaplasty in male-to-female transsexuals

Hormonal therapy and gender-confirming surgery are the treatments of choice in appropriately selected male-to-female transsexuals. Penectomy and vaginoplasty are the paramount surgical requests of the male transsexual, but breast enlargement greatly increases subjective feelings of femininity. There are only limited reports on augmentation mammaplasty in male transsexuals, and hardly any attention has been paid to the differences between the female mammary anatomy and its male counterpart. The basic anatomic and surgical considerations of augmentation mammaplasty for 201 male-to-female transsexuals who were operated on from 1979 to 1997 are reviewed and discussed. They include the differences between male and female anatomy and how to feminize the male chest, the results of hormonal therapy and the proper timing of surgery, the choice of implant size and surgical approach, the results that may be expected after surgery, and the implications of all mentioned on the long-term outcome and follow-up after augmentation mammaplasty. Because the referring doctor may not check on the breasts or may not be trained to examine augmented breasts for pathologic conditions, the mammaplastic surgeon has an obligation to ensure the proper follow-up of these patients.     

Augmentation mammaplasty by cadaver fat allografts

Two Soviet women were treated for complications of breast hardening and tenderness following augmentation mammaplasty using cadaver fat allografts. The cadaver fat grafts were excised and replaced with silicone-gel prostheses in the submammary pockets. The implants were found to contain necrotic fat tissue with areas of fibrosis and calcification; however, no signs of rejection were evident. Both patients had a successful postoperative outcome.     

Augmentation mammaplasty by means of the transrectus route

A new operative technique has been developed for augmentation mammaplasty. Through an inframammary incision, the anterior rectus sheath is entered, and the pocket is dissected in an entirely submuscular plane. We have performed this procedure in 112 patients to date. Complications have been few. The capsular contracture rate in 90 patients followed for greater than 1 year is 7 percent. The inframammary crease can be lowered using this technique, making mastopexy unnecessary in most patients with moderate ptosis.     

Augmentation mammaplasty and breast cancer: a 5-year update of the Los Angeles study.

We have previously reported on the risk of breast cancer in women during the first few years following cosmetic augmentation mammaplasty and are now presenting results after longer exposure. Long-term carcinogenicity of breast implants in humans has not been assessed previously. We conducted a retrospective cohort study of 3112 patients with a median of 10.6 years of postimplant experience (range 0.1 to 31.7 years). Patients were enrolled from surgeons' records, and cancer outcomes were monitored by the population-based cancer registry serving Los Angeles County. Because of confidentiality concerns, there was no direct patient contact. Twenty-one breast cancers were observed among the implant patients as compared with 31.7 expected, based on Los Angeles County incidence rates [standardized incidence ratio (SIR) = 66 percent, 95 percent confidence limits (CL): 41 percent, 101 percent]. For all other malignancies combined, 45 were observed and 50.0 were expected (SIR = 90 percent, CL: 66 percent, 120 percent). Although the numbers of cases were very small, increased frequencies of lung and vulvar cancers were observed. Based on the evidence to date, we conclude that there is no increase in breast cancer incidence following augmentation mammaplasty.     

"De-epithelization" of the dermal pedicle in a reduction mammaplasty.

Eleven biopsies in 6 consecutive patients having reduction mammaplasties by a technique which uses a dermal pedicle have established that dermis does remain in the pedicle. The term "de-epithelization" is not correct and should be abandoned in this context.     

Surgical thimble for use in augmentation mammaplasty

A conveniently formed thimble has been created for use in dissection during augmentation mammaplasty and gynecomastia operations which forms a rigid extension to the surgeon's finger. With the aid of this instrument, which is fitted onto the third and partly onto the second phalanx of the index finger, the delicacy and maneuverability characteristics of digital dissection are on the whole retained and the surgeon avoids the use of traditional dissection instruments gripped in the hand, with which it is easy to exceed the desired limits of dissection creating nervous lesions and unequal pockets.