Implant Folding Phenomenon in Cohesive Gel; Diagnosis of Suspected Implant Rupture in MRI Finding

Since the introduction of the 4th generation silicone gel implants, number of breast augmentation using so-called 'cohesive gel' implants has increased rapidly. Still, implant rupture remains the most annoying complication of breast implant surgery. Recently, magnetic resonance image (MRI) is used as the gold standard in diagnosis of implant rupture. We experienced patients diagnosed as implant rupture with MRI finding, whose implants were found not to be ruptured, but only folded. These patients underwent breast augmentation with cohesive gel and presented to our center with complaint of breast asymmetry and texture-related discomfort. We recommended MRI imaging for diagnosis and the result of radiological diagnosis were 'rupture of implant'. After surgical exploration, we found intact implants without rupture. They were severely folded and fixed with folded form. With our experience, we conclude that cohesive gel implants, due to their more cohesive and form-stable characteristics, sometimes tend to fold and fix in stable folded form and in such cases, MRI image can be similar with the image of ruptured implant. Therefore, in diagnosis of cohesive gel rupture, surgeons should consider both radiologic finding and physical examination carefully before the decision of exploration.

Augmentation Mammaplasty in Women with Simple Sunken Chest

PURPOSE: The sunken chest deformity without breast asymmetry is not a rare condition encountered in augmentation mammaplasty. Therefore, failure to recognize the deformity and improper surgical plan will lead to a suboptimal result. The authors review the experience of breast augmentation in simple sunken chest patient based on retrospectively collected data. METHODS: From January, 2008 to January, 2009, patients with simple sunken chest underwent endoscopic submuscular augmentation mammaplasty through axilla, using silicone implants. Patient demographics were queried and outcomes were assessed. RESULTS: Eleven patients (22 breasts) were followed up for 8.2 months after surgery. Sunken chests were augmented with implant size of approximately 248.9 cc (range: 213~286 cc) and contralateral chest with 211.4 cc (range: 180~235 cc). Simultaneous camouflaging the chest wall depression with breast augmentation resulted in good aesthetic outcome. All of the patients were satisfied with the surgery. There were no complications among all patients. CONCLUSION: We have demonstrated proper surgical planning with precise implant selection to optimize results in patients with small breast and simple sunken chest. Even though asymmetry still remains after the operation, it is still considered as acceptable.

Submuscular periareolar approach to augmentation mammoplasty

No Abstract Available.

The Reliability of Ultrasonographic Fending of Silicone Breast Implant Rupture

This retrospective study evaluated possible rupture of silicone gel breast implants in 92 patients. the series included patients undergone augmentation mammoplasty(n=59), and reconstructive mammoplasty(n=23) from Sep. 1993 to Aug. 1996. the age of implants ranged from 4 months to 8 years(mean:23.1months). of these, 19 cases displayed Ultrasonographic sings of rupture. of 13 implants removed, 7 were intact and 6 were ruptured. Implant contour deformities and radial folds are often seen in both ruptured and intact silicone implants and therefore cannot serve as reliable signs of rupture. A stepladder sign in intact implant is believed to be the result of reverberation artifacts within the interior of the implant. Due to these false-positive ultrasonographic findings, ultrasonographiy is not as absolutely reliable tool for the diagnosis of implant rupture. Alternative imaging methods(CT, MRI) are required to establish an accurate preoperative diagnosis.

Histologic study of chemical peel in guinea pig after pretreatment with tretinoin and tretinoin-combined pretreatment kit

The purpose of this study was to evaluate the histologic difference that occured after trichloroacetic acid(TCA) chemical peel in an animal model that was pretreated with Tretinoin alone or Tretinoin-based combined pretreatment kit. Eight Hartley white guinea pigs were used in our study. The dorsal skin of the guinea pigs was divided into six equal squares(2x2 cm). Upper two areas of these six were not pretreated, middle two areas were pretreated for 4 weeks with Tretinoin alone and lower two areas were pretreated for 4 weeks with Tretinoin-based combined kit. Each guinea pig underwent chemical peel with 50% TCA. The wounded areas were biopsied at post-peeling 3 weeks and 6 weeks. The histology revealed that those animals pretreated with combined kit healed quicker than the animals pretreated with Tretinoin alone. This study implies that if patients are treated with Tretinoin-based-combined pretreatment kit before undergoing chemical peel, the pretreatment time will be shortened.