Autologous augmentation-mastopexy after bariatric surgery: waste not want not!

BACKGROUND: The escalating trend in obesity is having major impact on health and the economy. As a result of NHS policies to reduce obesity, the number of patients losing weight following bariatric surgery is increasing rapidly. In addition to the systemic benefits to their general health, dramatic weight loss leads to marked changes in body habitus, with many patients seeking further "aesthetic" surgery to improve their appearance. We present our technique of autologous augmentation-mastopexy to address the problems of both skin excess and insufficient breast volume. METHODS: Our chosen method for mastopexy uses the Wise-pattern skin excision. Augmentation of the breast deficient in volume is provided by a pedicled subcutaneous lateral thoracic perforator-based flap raised via a vertical continuation of the lateral mastopexy incision superiorly, often in continuity with a simultaneous brachioplasty incision. RESULTS: Thus far, six patients have undergone autologous augmentation mastopexy following massive weight loss (range = 36-79 kg, mean = 61 kg). Follow-up of these patients ranged from 1 to 18 months (mean = 12.5 months). Postoperative complications included a donor site seroma, haematoma, and scar contracture. All patients tolerated the procedure well and they felt that the improvement in breast and chest wall contour more than compensated for the donor site scar on the lateral chest wall. CONCLUSION: Autologous augmentation-mastopexy provides a robust augmentation, giving more natural ptotic breasts while avoiding the cost and potential complications of implant augmentation. The increased lateral flank scarring is well tolerated by these patients, with the additional benefit of reducing flank fullness.

Prevalence of rupture in inamed silicone breast implants.

BACKGROUND: Silicone breast implants have been used for decades and are arguably the most studied implantable device. However, the vast body of scientific literature has been unable to establish a definitive rupture rate. Various studies have evaluated implant rupture, but the meaningfulness of these data was confounded by the inclusion of different generations of implants and multiple manufacturers' implants and the selection of subjects who were already suspected of having ruptured implants. The authors' study was designed to acquire long-term rupture data specific to Inamed's third-generation silicone breast implants using magnetic resonance imaging technology. METHODS: A total of 106 women with at least one Inamed silicone breast implant (styles 40, 110, and 120) were enrolled in this multicenter, cross-sectional study. The majority received implants for cosmetic augmentation (n = 77, 72.6 percent), with a smaller number having undergone breast reconstruction (n = 11, 10.4 percent) or revision of previous breast implant operations (n = 18, 17.0 percent). Most subjects were Caucasian (n = 99, 93.4 percent) with a median age at implantation of 34 years (range, 18 to 70 years). Enrolled subjects underwent a physical examination and magnetic resonance imaging screening at one of five sites to determine the prevalence of asymptomatic rupture. RESULTS: A total of 199 implants were evaluated, with a median implantation time of 10.9 years (range, 9.5 to 13.2 years). Overall, 183 implants (92.0 percent) showed no evidence of rupture, 12 (6.0 percent) showed evidence of rupture, and four (2.0 percent) were indeterminate. All indeterminate evaluations were considered ruptures, providing a worst-case rupture prevalence of 8.0 percent. CONCLUSION: The study results establish a rupture prevalence rate of 8.0 percent at 11 years for Inamed's silicone breast implants.