Does Implant Insertion with a Funnel Decrease Capsular Contracture? A Preliminary Report.

BACKGROUND: Capsular contracture remains a common and dreaded complication of breast augmentation. The etiology of capsular contracture is believed to be multi-factorial, and its causes may include biofilm formation due to implant/pocket contamination with skin flora. It has been shown that insertion funnel use reduces skin contact and potential contamination by 27-fold in a cadaver model. After incorporating the funnel into our surgical protocols, we anecdotally believed we were experiencing fewer capsular contractures in our augmentation practices. OBJECTIVES: The purpose of this study was to test the hypothesis that capsular contracture related reoperation rates decreased after insertion funnel adoption using data from multiple practices. METHODS: At seven participating centers, we retrospectively reviewed the surgical records from March 2006 to December 2012 for female patients who had undergone primary breast augmentation with silicone gel implants. Group 1 consisted of consecutive augmentations done without the insertion funnel, and Group 2 consisted of consecutive augmentations done with the insertion funnel. The primary outcome variable was development of grade III or IV capsular contracture that led to reoperation within 12 months. RESULTS: A total of 1177 breast augmentations met inclusion criteria for Group 1 and 1620 breast augmentations for Group 2. The rate of reoperation due to capsular contracture was higher without use of the insertion funnel (1.49%), compared to Group 2 with funnel use (0.68%), a 54% reduction (P = 0.004). CONCLUSIONS: The insertion funnel group experienced a statistically significant reduction in the incidence of reoperations performed due to capsular contracture within 12 months of primary breast augmentation.

Four-dimensional breast imaging, part II: clinical implementation and validation of a computer imaging system for breast augmentation planning.

BACKGROUND: No publications exist describing the impact of three-dimensional imaging on the consultation process for breast augmentation, nor have existing software products claiming simulation features been validated. OBJECTIVES: The authors describe the application of four-dimensional technology during patient consultation to assist in planning implant size and type. METHODS: Forty-six primary breast augmentation patients underwent preoperative consultation with 4D simulation software; 35 out of 46 also received follow-up imaging. At six months postoperatively, simulated measurements were compared to actual measurements and questionnaires were mailed to patients asking them to assess the imaging experience. A follow-up phone survey 18 months postoperatively examined the persistence of patient attitudes about implant size and imaging. Practice productivity was evaluated by comparing specific parameters (such as scheduling rates) between three separate time periods for the same clinic. RESULTS: Across all parameters, breast augmentation simulations correlated highly with positive surgical outcomes (R-value = 0.68). The majority (95%) of patients believed the simulations were accurate; 89% also expressed that it enhanced trust in the surgeon and 74% reporting that it helped in choosing an implant size. Despite 48% also indicating that they would select a larger implant if they were to undergo surgery again, no patients have undergone reoperations of any kind. Compared to historical controls, scheduling rates in the practice increased from 40% to 77% after addition of simulation software. CONCLUSIONS: 4D breast imaging appears to be an accurate system for analysis, planning, simulation, and patient education for women considering primary breast augmentation, and application of this technology during the consultation process was correlated with a high degree of patient satisfaction and practice productivity.

Four-dimensional breast imaging, part I: introduction of a technology-driven, evidence-based approach to breast augmentation planning.

Although there are many three-dimensional imaging systems currently available on the market, all of them require a high degree of interaction on the part of the user, making them clinically impractical. Moreover, though claims have been made regarding the validity of these systems for imaging the breast form, there have been no previous reports validating any commercially-available implant simulation models in the plastic surgery literature. In this article, the authors describe the development and evaluate the efficacy of a novel four-dimensional (automated three-dimensional) breast imaging system, validating it as an evidence-based simulation tool for patient consultation, surgical planning, and outcomes analysis in cosmetic breast augmentation. This report, based on a series of longitudinal correlation studies with several patient cohorts, found a highly statistically significant degree of correlation and reliability between the automated measurements obtained with the four-dimensional system and manual measurements.

Incidence of breast and chest wall asymmetries: 4D photography.

BACKGROUND: Few authors have addressed preoperative soft tissue and chest wall analysis as it pertains to asymmetries that must be identified for preoperative breast augmentation planning. OBJECTIVES: The authors evaluate the incidence of breast and chest wall asymmetries. METHODS: In the present study, 125 consecutive patients underwent a voluntary dimensional analysis by a single practitioner, followed by a confirmatory 4D photographic analysis. During each patient's evaluation, the following measurements were recorded: distance from nipple to inframammary fold (IMF), base width, distance from sternal notch to nipple, horizontal areolar width, vertical areolar height, upper and lower pole pinch tests, and medial and lateral pinch tests. RESULTS: Following exclusion of patients who had undergone prior breast surgery, 117 patients were included in the final statistical analysis. Significant differences between right and left breasts were found in 81.7% of patients in one or more of the measured dimensions (p < .05). The manual measurements were confirmed with computerized 4D photography, and there was no significant difference found between the two measurement types in any objective parameter. However, there was a significant difference in the level of chest wall asymmetries identified by 4D photography. Nipple-to-IMF position asymmetry was present in 59.6% of the patients, and sternal notch-to-nipple asymmetry was present in 81.2%. Overall, 100% of the women had some degree of asymmetry (soft tissue and/or chest wall) confirmed by 4D photography. CONCLUSIONS: The 4D photography measurements in this study were consistent with objective manual measurements but provided the added benefit of identifying chest wall asymmetries more objectively. The data from this study underscore the importance of developing a systematic preoperative breast and chest wall analysis that can be individualized for each patient. The resulting asymmetries should then be discussed with the patient, along with the potential for continued or more pronounced asymmetry postoperatively.