Technical Refinements for Reducing Reoperations in Single-Stage Augmentation Mastopexy: A Retrospective Matched Cohort Study.

BACKGROUND: The goals of mastopexy differ significantly from those of augmentation mammoplasty. Mastopexy is designed to lift and reshape the breasts, while augmentation mammoplasty is designed to increase the volume of the breasts. This conflict causes that one-stage augmentation mastopexies showed a revision rate from 8.7 to 23.2%. The aim of our study is to present some technical refinements for reducing the risk of implant exposure and reoperation. METHODS: We designed a retrospective matched cohort study, including 216 consecutive patients, undergone augmentation mastopexy between January 2013 and December 2022. We divided them in two groups: Group A undergone an inverted-T superomedial pedicled augmentation mastopexy and Group B undergone our inverted-T modified augmentation mastopexy. The groups were matched for clinical and surgical variables, with the surgical technique the only difference between the two. RESULTS: Complications were registered in ten patients (9.3%) in Group A (two wound breakdowns at T with implant exposure and eight wound dehiscences), six of which required surgical revision. In contrast, only three patients (2.8%) in Group B reported a complication, which was wound dehiscence without implant exposure in all cases. None of the dehiscence required surgical revision. The difference between complication and revision rates was statistically significant. CONCLUSIONS: Separating the implant and the mastopexy dissection planes reduces the implant exposure and the reoperation rate in one-stage augmentation mastopexy. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

Infective Costochondritis after Augmentation Mammoplasty: A Rare Case Report and Review of the Literature.

Silicone breast implant insertion is a commonly performed surgical procedure for breast augmentation or reconstruction. Among various postoperative complications, infection is one of the main causes of patient readmission and may ultimately require explantation. We report a case of infective costochondritis after augmentation mammoplasty, which has rarely been reported and is therefore difficult to diagnose. A 36-year-old female visited the clinic for persistent redness, pain, and purulent discharge around the left anteromedial chest, even after breast implant explantation. Magnetic resonance imaging showed abscess formation encircling the left fourth rib and intracartilaginous and bone marrow signal alteration at the left body of the sternum and left fourth rib. En bloc resection of partial rib and adjacent sternum were done and biopsy results confirmed infective costochondritis. Ten months postoperatively, the patient underwent chest wall reconstruction with an artificial bone graft and acellular dermal matrix. As shown in this case, early and aggressive surgical debridement of the infected costal cartilage and sternum should be performed for infective costochondritis. Furthermore, delayed chest wall reconstruction could significantly contribute to the quality of life.

Impact of Incisional Access Site in Primary Breast Augmentation: Evaluation of Patient Satisfaction with SCAR-Q.

BACKGROUND: Scarring at the incision site represents one of the most impactful outcomes in breast augmentation surgery for both the patient and the surgeon. Few studies exist with the aim of assessing patient perception of scarring outcomes in primary breast augmentation. The aim of this study was to evaluate the impact on quality of life of scars by submitting the SCAR-Q in patients who underwent primary augmentation mammoplasty. METHODS: The SCAR-Q was administered at one and at 6 months after surgery to 54 consecutive patients underwent primary breast augmentation with inferior hemi-periareolar or inframammary incision. A total of 50 patients were divided into two groups of 21 patients with inferior hemi-periareolar incision and 29 patients with inframammary fold incision, respectively. Statistical analysis was performed with Prism 9. RESULTS: All mean values of the three SCAR-Q scales tend to decrease at the second administration meaning that the perception of the scar is better at time 6 from the patient perspective. In the "Psychosocial scale," lower values at both 1 month and 6 months for group 2 compared to group 1 were shown. Unpaired T tests with Welch's correction showed significance for delta values variations between the two groups with P values <0.0001. CONCLUSION: Data show that patients undergoing primary breast augmentation have a scar that has no significant impact. Patients with inframammary fold scar have less psychosocial impact than those with inferior hemi-periareolar scar. There were no statistically significant differences in scar-related symptoms and scar appearance between scar along the inframammary groove and inferior hemi-periareolar scar. LEVEL OF EVIDENCE IV: Case series study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Galactorrea y galactocele: factores de riesgo e implicaciones en el aumento de mama / Galactorrhea and galactocele: risk factors and implications for breast augmentation

Introducción y objetivo: El aumento de mama es el procedimiento quirúrgico estético más realizado en mujeres en todo el mundo. La galactorrea es una complicación rara posterior al aumento mamario con implantes, con una incidencia del 0.96% y solo 38 casos reportados en la revisión sistemática más reciente del 2021, aunque con posibles consecuencias a corto y largo plazo altamente significativas. Presentamos nuestra serie de casos de galactorrea asociada a colocación de implantes de mama y revisamos las publicaciones sobre el tema con la finalidad de comprender la fisiopatología y establecer un protocolo de prevención, diagnóstico y tratamiento oportuno y efectivo en estos casos. Material y método: Revisión retrospectiva documental y fotográfica de nuestra experiencia en 5 años con aumento de mama primario y galactorrea, así como búsqueda en PubMed, Embase y Google Académico con las palabras claves en inglés: Galactorrhea, Galactocele, Breast augmentation, Augmentation mammoplasty, Breast implants adverse effects. Resultados: Entre 2015 y 2020 se realizaron en nuestra clínica de la Ciudad de México 2.232 procedimientos de aumento de mama, entre los cuales evidenciamos galactorrea / galactocele en 7 pacientes (incidencia del 0.31%) que requirieron estrategia diagnóstica y de tratamiento farmacológico / quirúrgico. En la búsqueda bibliográfica encontramos 20 artículos: 17 series de casos, 2 revisiones retrospectivas y 1 revisión sistemática. Conclusiones: Con la información disponible, evidencia existente y nuestra experiencia proponemos una pauta sencilla y completa para determinar factores de riesgo preoperatorios, abordaje diagnóstico y niveles terapéuticos efectivos para disminuir las posibles complicaciones a corto y largo plazo de la galactorrea / galactocele asociados al aumento de mama con implantes. (AU)

Background and objective: In women, breast augmentation is the most performed aesthetic surgical procedure in the world. Galactorrhea is a rare complication after breast augmentation with implants, with an incidence of 0.96% and only 38 cases reported in the most recent systematic review of 2021, although with possible highly significant short- and long-term consequences. We present our series of cases of galactorrhea associated with the placement of breast implants and review the publications on the subject to understand the pathophysiology and thus establish a protocol or guideline for timely and effective prevention, diagnosis and treatment in these cases. Methods: A documentary and photographic retrospective review of our 5-year experience with primary breast augmentation and galactorrhea was carried out, as well as a search in PubMed, Embase and Academic Google with the keywords in English: Galactorrhea, Galactocele, Breast augmentation, Augmentation mammoplasty, Breast implants adverse effects. Results: Between 2015 and 2020, in our clinic in Mexico City, 2.232 breast augmentation procedures were performed, of which we evidenced galactorrhea / galactocele in 7 patients (0.31% incidence), who required a more complex diagnostic strategy and pharmacological / surgical treatment. In the search for information in the literature we found 20 articles: 17 case series, 2 retrospective reviews and 1 systematic review. Conclusions: With the available information, existing evidence, and our experience we propose a simple and complete guideline for the determination of preoperative risk factors, diagnostic approach and effective therapeutic levels to reduce the possible short and long-term complications of surgery in galactorrhea / galactocele associated with breast augmentation with implants. (AU)

False-Positive Nodes With Axillary Silicone Lymphadenopathy in an Oncologic Patient With a Rare Breast Cancer and Implant Rupture.

In this case, a 43-year-old woman with a rare breast tumor and a history of augmentation mammoplasty is presented. The patient arrived at the clinic reporting a palpable lump in the right mammary gland and two ipsilateral axillary nodes with pain on palpation. Mammography and ultrasound confirmed the presence of a 4 cm tumor and 2 metastatic lymph nodes of 2 cm each, histopathological diagnosis was an encapsulated papillary cancer and two siliconomas, respectively. Interestingly, these nodes were able to take up technetium 99 and methylene blue contrast media. Due to these findings, adequate patient management was carried out with a skin-sparing mastectomy and hormonal treatment with tamoxifen. This report is relevant as it shows that axillary lymphadenopathy caused by silicone must be considered in the evaluation of a patient with a cancer diagnosis and history of augmentation mammoplasty, especially breast cancer as the node siliconomas present a high risk of being considered a false positive metastasis.

Basic Strategies of Augmentation Mammoplasty in Patients with Tendencies of Pectus Excavatum and Carinatum.

BACKGROUND: In this era of growing popularity of cosmetic surgeries, more women of various chest wall shapes are likely to receive augmentation mammoplasty. Pectus excavatum (PE) and pectus carinatum (PC) are the two most common chest wall deformities, and many asymptomatic patients visit the clinic. In this study, we presented various strategies for successfully performing breast augmentation in PE and PC patients without long-term complications such as symmastia. METHODS: From January of 2019 to December of 2021, a total of 132 patients with tendencies of PE and PC received augmentation mammoplasty in our institute. We retrospectively reviewed data on demographics, surgical procedure, outcomes, and complications. RESULTS: Among the 132 cases, 71.21% were done via inframammary approach, and 28.79% via transaxillary approach. The mean implant volume was 337.25 ± 51.46 ml, and the mean follow-up period was 16.48 ± 6.74 months. The Likert scale of outcome satisfaction scored 9.13 ± 0.48. No symmastia occurred. CONCLUSION: We presented our basic strategies of breast surgery in patients with various chest wall anomalies. Augmentation mammoplasty can benefit PE and PC patients physically as well as psychologically, to carry out healthy positive lives. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Resection of superior polar gland flap of the breast combined with dual plane augmentation through Omega nipple root approach / 中华医学美学美容杂志

Objective:To investigate the feasibility of superior polar gland flap resection combined with biplanar augmentation mammoplasty through the root of the nipple to correct pseudoptosis/mild breast ptosis.Methods:From January 2019 to January 2021, 20 patients (40 breasts) with pseudoptosis/mild breast ptosis underwent augmentation mammoplasty with superior polar gland flap through the root of the nipple and microvilli anatomical silica gel prosthesis.Results:No postoperative complications such as hematoma infection, capsular contracture and abnormal sensation of the nipple and areola were found in 20 patients. During the follow-up of 3 to 18 months, the patients' breasts were plump and straight, the appearance was good, and the prolapse was basically corrected. Postoperative satisfaction was achieved in 20 cases (95%), and the satisfaction of incision scar was 100%.Conclusions:The comprehensive surgery restores the normal anatomical suspension system of the breast, achieves a long-term mechanical stable balance among prosthesis, muscle, breast gland and skin, and receives high satisfaction with breast shape after operation.

Distant migration of gel filler: imaging findings following breast augmentation.

Recently, many attempts have been made to use injectable materials in the subcutaneous fat layer anywhere in the body, including the breast and face, for cosmetic purposes. A 56-year-old woman presented with multiple palpable lumps without tenderness or skin color changes on the anterior and lateral chest and the abdominal walls. Magnetic resonance imaging showed fluid-like collections without surrounding soft tissue inflammatory changes in the chest wall, abdominal wall, and deeper within the abdomen. The lesions penetrated the peritoneum and were observed adjacent to the liver dome. Ultrasonography also showed hypoechogenicity suggestive of fluid collection in the left axilla and trunk. The differential diagnosis based on radiologic findings included parasite manifestation, non-specific inflammatory conditions, and chronic granulomatous infections such as tuberculosis or non-tuberculous mycobacterial infections. However, these conditions are usually accompanied by changes in the adjacent subcutaneous fat layers, but our patient did not show any other abnormalities in the adjacent soft tissue. After biopsy and aspiration analysis, the patient was found to have a history of filler injection for breast augmentation approximately 17 years prior. It is often difficult to make a differential diagnosis without detailed knowledge of the patient's medical history. Here we describe a rare case of distant migration of the filler to the axilla, chest wall, abdominal wall, and peritoneum following breast augmentation with filler injection. Knowledge of the radiologic characteristics and migration patterns of gel fillers and their related complications is useful for making an accurate diagnosis.

Layered Mastopexy with Augmentation in Muscle Splitting Biplane: A Modification for Lower Pole Safety and Stability.

BACKGROUND: Single-stage mastopexy with augmentation is a commonly performed procedure. The single-stage procedure can be performed in primary cases or a secondary procedure in patients with previous history of augmentation, mastopexy or mastopexy with augmentation. The procedure is challenging and not without its risks. METHODS: A retrospective chart review of all consecutive cases of layered mastopexy with augmentation mammoplasties, carried out from September 2015 to August 2019, was performed. All patients had their implants placed in muscle splitting pocket first and access for the pocket was closed prior to the commencement of mastopexy. RESULTS: During the period of 4 years, 102 consecutive layered mastopexy with augmentations were performed in muscle splitting plane. Of these 102 patients, 74 (72.5%) patients had it as a primary and 28 (27.5%) as a secondary procedure. Of these 102 patients, 53 (52.0%) had textured, 37 (36.3%) had smooth and 12 (11.8%) had microtextured implants and 72 (70.6%) patients had high profile and 30 (29.4%) had medium profile implants. Same size implant was used in 89 patients with a mean of 298 cc, and 13 patients had different size implants with a mean of 362 cc on the right and 395 cc on the left. In current study, bilateral periareolar, vertical scar cat's tail and Wise pattern mastopexies were performed in 11, 51 and 27 patients, respectively. Of the 102 patients, 5 had unilateral right periareolar, 5 unilateral right vertical scar cat's tail, 2 unilateral left periareolar and 1 patient had a combination of periareolar and vertical scar combination. There was no nipple loss or periprosthetic infection. There was a minor wound breakdown seen in 4 (3.9%), haematoma in 2 (2.1%), nipple sensation loss in 2 (2.1%) and 12 (11.8%) had layered mastopexy as a part of a combined procedure. Revision was performed in 6 (6.5%), drains were used in 14 (13.7%), and 92 (90.2%) had the procedure performed as a day case. CONCLUSION: Layered mastopexy with augmentation is a safe procedure with added stability and safety to lower pole of the breast as well as nipple-areolar complex. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correction of Areolar Protuberance During Augmentation Mammoplasty in Transfemale Patients.

Augmentation mammoplasty refers to "top surgery" for transfemale patients. Before this surgery, due to the hormonal treatment being taken, it may be encountered that there would be a glandular tissue of breast that seems to be similar to the simple tuberous breast disease, which is one of the diseases in female breast development. The presence of areolar protuberance in transfemale would of course undermine the cosmetic gain after augmentation mammoplasty operation. This situation, which can be difficult to diagnose before surgery especially in transfemale patients, will manifest itself clearly after the end of augmentation mammoplasty. As a precaution, resection of a part of glandular tissue equal to the protruding height of the areola from the posterior wall of the gland is an effective method both in terms of its simple applicability and not to use of an extra skin incision while performing augmentation mammoplasty.

Late Campylobacter jejuni mastitis after augmentation mammoplasty.

Breast implant-associated infections (BIAI) occur in approximately 2% of patients after augmentation mammoplasty. In some cases, BIAI can be treated conservatively, whereas others need implant removal. Knowledge of uncommon potential pathogens in BIAI is important to ensure optimal treatment of BIAI. In the present case report, we describe a case of bilateral late Campylobacter jejuni mastitis in a 34-year-old woman without previous symptoms of gastroenteritis. While Staphylococci are common causative pathogens in BIAI, there are numerous potential pathogens. This case highlights the importance of careful consideration of antibiotic treatment and switch to broad-spectrum antibiotic regimen in BIAI not responding to initial treatment.

Breast Aesthetic Preferences: Analysis of 1294 Surveys.

BACKGROUND: Aesthetic breast perceptions could be variable among cultures. Fullness, superior/inferior pole proportion and orientation and size of the nipple areolar complex are key elements in patient post-operative satisfaction and should be considered when planning breast aesthetic surgery. METHODS: A descriptive study was designed, using an online survey, sent via social media. Standardized software modified images of breasts with different pole proportions, areolar nipple complex orientation and size were used. RESULTS: From 1294 surveys collected, 1291 were analysed (969 women and 322 men). Significant differences in preferences of upper/lower pole breast proportions were found among groups of different age, gender, level of education and previous history of breast surgery. CONCLUSIONS: In the studied population, we found several variations in aesthetic breast preferences related to their demographic characteristics and for this reason we believe that this research may serve as a "macro" guide for both patient and surgeon in primary and secondary breast surgery. To our knowledge, this is the largest survey study concerning breast aesthetic preferences done in Colombia and second largest in the world. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Splenic marginal zone B-cell lymphoma associated with ruptured breast implants: case report and review of the literature.

We describe splenomegaly and bilateral grade 2 Baker breast capsular contracture in a woman who had undergone augmentation mammoplasty. This case represents the first documented instance of splenic marginal zone lymphoma, and is among the rare reports of B-cell lymphoma, arising in a patient with breast implants.

Tromboembolismo pulmonar decorrente de tromboflebites venosas superficiais em membros superiores pós-cirurgia plástica mamária estética: relato de 3 casos / Pulmonary thromboembolism due to superficial venous thrombophlebitis in upper limbs after cosmetic breast plastic surgery: report of 3 cases

Tromboses e tromboflebites superficiais de membros superiores são doenças frequentes e muitas vezes pouco valorizadas. Relatamos três pacientes no pós-operatório de cirurgias plásticas mamárias estéticas que apresentaram tromboflebite em membros superiores e que evoluíram com tromboembolismo pulmonar. Todas as pacientes apresentaram quadro clínico típico, com comprovação pelo Doppler ultrassonografia de trombose/flebite superficial de membros superiores e ausência de lesões em membros inferiores, bem como aumento de dímero-D e comprovação da embolia pulmonar por tomografia computadorizada ou cintilografia pulmonar. Os três casos evoluíram com melhora após anticoagulação e sem sequelas.

Superficial thrombosis and thrombophlebitis of the upper limbs are frequent and often underestimated diseases. We report three patients in the postoperative cosmetic breast plastic surgery period who presented thrombophlebitis in the upper limbs and who evolved with pulmonary thromboembolism. All patients had a typical clinical picture, with Doppler ultrasound evidence of thrombosis/superficial phlebitis of the upper limbs and absence of lesions in the lower limbs and an increase in D-dimer and evidence of pulmonary embolism by computed tomography or pulmonary scintigraphy. The three cases evolved with improvement after anticoagulation and without sequelae.

Revisionary Surgery Following Primary Augmentation Mammoplasty in Muscle Splitting Biplane Pocket: An Appraisal of 93 Revisionary Surgeries.

BACKGROUND: Muscle splitting augmentation mammoplasty is the creation of a submuscular pocket which is gaining attention and acceptance by plastic surgeons worldwide. First introduced in 2007, muscle splitting augmentation mammoplasty has since been used for primary and secondary augmentation mammoplasty and augmentation mastopexy procedures. A personal experience of revision surgeries following muscle splitting augmentation mammoplasty is presented. METHODS: A retrospective data analysis for revision surgeries, following muscle splitting primary augmentation mammoplasties, performed between October 2005 and October 2018 was carried out. RESULTS: A total of 1511 primary augmentation mammoplasties were performed. Of these 1511 patients, 93 (6.1%) patients had revisionary or secondary surgery. The mean age of the patients was 33.8 + 9 years (range 20-60). Of the 93 patients, 78 patients had same size implants, mean 337 cc + 53.5 (range 230-495), and 14 had different size implants. Of these 14 patients, mean implant size on right and left was 331 cc + 59.4 (range 225-425) and 351 cc + 61.7 (range 260-450), respectively. Of the recorded texturing in 1495 patients, only 3.1% had smooth implants. Leading causes for revision were implant exchange for various reasons, in 33 (35.4%); 25 (26.8%) wanted larger implants, revisionary surgery for capsular contracture in 18 (19.3%), implant rupture was seen in 9 (9.6%), 4 (4.3%) patients had surgery for recurrent back-to-front flipping, 2 (2.1%) patients wanted a smaller size, 1 (1.07%) patient had fold flaw failure, and in 1 (1.07%) the cause was not recorded. There were no haematoma and breast implant-associated anaplastic large cell lymphoma (BIA ALCL) recorded in the series. CONCLUSION: The incidence of revisionary surgery following muscle splitting primary augmentation mammoplasty is acceptable and can be corrected using the described techniques. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Periprosthetic Infection in Primary and Secondary Augmentation Mammoplasty Using Round Silicone Gel Breast Implants: Comparative Analysis of 2521 Primary and 386 Secondary Mammoplasties in a Single Surgeon Practice.

INTRODUCTION: Wounds are generally classified as clean, clean contaminated, contaminated and dirty. Aesthetic surgery, including breast augmentation, is classified as clean or clean contaminated. The presence of bacteria on the skin, in nipple secretions, in superficial and deep parenchymal samples and also the presence of bacteria in capsules and on implants justifies the use of antibiotics. However, there is a paucity of information about whether added bacterial flora on the capsule of the implant pockets, and the handling of these capsules as capsulotomy or capsulectomy makes secondary augmentation mammoplasty more prone to wound healing issues or periprosthetic infection. The current study is the analysis carried out between primary and secondary augmentation mammoplasties to look at the incidence of periprosthetic infection between the two groups. MATERIAL AND METHODS: A retrospective data analysis for periprosthetic infection and wound healing issues following primary and secondary augmentation mammoplasties performed between April 1999 and April 2019 was carried out. RESULTS: A total of 2521 (5042 breasts) primary and 386 (772 breasts) secondary augmentation mammoplasty data were available for analysis. Periprosthetic infection was seen in 0.7% and 0.5% of the primary and secondary augmentations, respectively, with no significant difference. Wound healing issues were significantly higher in primary augmentation mammoplasty. CONCLUSION: There was a marginally higher incidence of periprosthetic infection in primary augmentation mammoplasty as compared to secondary augmentation mammoplasty; however, the difference was not significant. On the contrary, the wound healing and superficial skin issues were higher in primary as compared to secondary augmentation mammoplasty, and the difference was statistically significant. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online instructions to Authors www.springer.com/00266 .

Evaluation of satisfaction and well being with Breast-Q© of aesthetic breast augmentations by implants using the "Dual Plane" technique: A serie of 191 cases.

INTRODUCTION: Dual Plane allows, according to J.B Tebbetts, to combine the advantages while reducing the drawbacks of the other implantation pockets. We assessed patient satisfaction using the Breast-Q © questionnaire after breast augmentation using the Dual Plane technique. MATERIAL AND METHODS: Our study involved evaluating data from the Breast-Q © questionnaire from 191 patients retrospectively. Other secondary criteria were studied such as postoperative complications, the correlation between satisfaction and implant volume, satisfaction and operating time, satisfaction and age of the patient. RESULTS: The Breast-Q © questionnaire allows us to assess the satisfaction of the patients in our series about their breasts, their implants, the information received and the outcome of the intervention. Physical, sexual and psychosocial well-being is also assessed. CONCLUSION: Breast augmentation using a Dual Plane pocket according to Tebbetts achieves significant levels of satisfaction and well-being in patients. To our knowledge, this is the most important series devoted to the evaluation of these criteria after the use of the Dual Plane.

Effect of contralateral augmentation on postoperative complications after the second stage of tissue expander/implant breast reconstruction.

BACKGROUND: Contralateral augmentation mammoplasty in implant-based reconstruction could potentially lead to deterioration of the thickness of the mastectomy skin flap and increase postoperative complications of the reconstructed breast. We compared the complication rates of the reconstructed breast in the augmentation and no-augmentation groups among patients undergoing tissue expander/implant breast reconstruction. METHODS: Patients who underwent mastectomy followed by tissue expander/implant breast reconstruction between February 2010 and April 2018 were retrospectively reviewed. The primary outcome measures were complications and the need for a revision operation. The augmentation and no-augmentation groups underwent propensity score-matched analysis and the matched cases underwent multivariable logistic regression analysis. RESULTS: From the 234 patients in the augmentation group and 517 patients in the no-augmentation group, 200 propensity score-matched pairs were obtained. Analysis of the matched pairs revealed that the augmentation group as compared to the no-augmentation group showed a significantly higher overall complication rate (13.5 percent versus 6.5 percent; P=0.025) and revision operation rate (9.0 percent versus 3.0 percent; P=0.019). Multivariable conditional logistic regression analyses of the matched cases revealed that contralateral augmentation (odds ratio, 3.457; 95% confidence interval, 1.039-11.498; P=0.043) was associated with increased odds for a revision operation of the reconstructed breast. CONCLUSIONS: This study investigated the postoperative complications of the reconstructed breast associated with contralateral augmentation mammoplasty in patients who underwent mastectomy followed by tissue expander/implant breast reconstruction. The augmentation group had a higher revision operation rate than did the no-augmentation group. A clinical evaluation of the risks and benefits of contralateral augmentation and preoperative counseling may be indicated for patients who are undergoing implant-based breast reconstruction and are candidates for contralateral augmentation mammoplasty.

Simultaneous Augmentation Mammoplasty and Vacuum-Assisted Breast Biopsy for Enhanced Cosmesis and Efficacy.

BACKGROUND: In this era of expanding life expectancy and popularity of aesthetic breast surgeries, more women are likely to live more years with their augmented breasts. Thus, consistent attention to general breast health is crucial, and preoperative ultrasound is helpful to locate suspicious lesions. In this study, we present a combinative procedure of augmentation mammoplasty and vacuum-assisted breast biopsy (VABB). METHODS: From January of 2018 to December of 2019, a total of 102 patients received simultaneous augmentation mammoplasty and VABB in our institute. Only patients of primary augmentation mammoplasty who received VABB on unilateral breasts were included. We sought to investigate the results of each breast and safety of adding VABB before performing augmentation within the same incision. RESULTS: Among 204 breasts and implants, 28.43% were done via endoscopic transaxillary approach and 71.57% via inframammary approach. The mean implant volume was 329.34 ± 44.79 ml, and the mean follow-up period was 14.23 ± 4.64 months. All of the complication rates exhibited no statistically significant differences between the two groups. CONCLUSION: Simultaneous augmentation mammoplasty and VABB prevented unnecessary scars and pain, and the complication rates did not statistically differ from those of augmentation only group. This co-operation is a safe and simple method potentially beneficial to many women interested in breast surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nipple Dimensions After Augmentation Mammoplasty, Mastopexy and Reduction Mammoplasty: A Comparative Clinical Study.

BACKGROUND: Nipple hypertrophy is a rare aesthetic problem. Ideal nipple dimensions are 6-8 mm, while nipples larger than 10 mm are considered hypertrophic. PATIENTS AND METHODS: A total of 24 female patients, aged between 22 and 53 years, with a nipple diameter or height greater than 10 mm, underwent augmentation mammoplasty (AM), augmentation mastopexy (AUM) and reduction mammoplasty (RM) operations. The patients were divided into three groups according to the type of surgery containing equal numbers of patients. Group I underwent AM, Group II underwent AUM and Group III underwent RM surgery. Preoperative and 1-year post-operative nipple dimension measurements were performed, and the results were compared. RESULTS: There was no significant difference between the preoperative nipple volumes among the groups (p > 0.05). There was no significant difference between preoperative and post-operative nipple volumes in Group I (p > 0.05). The difference between preoperative and post-operative nipple volumes in Group II and Group III was significant (p < 0.05). When post-operative dimension comparisons were taken into consideration, there was a significant difference between Group I compared to Group II and Group III (p < 0.05); however, the difference between Group II and Group III was not significant (p > 0.05). CONCLUSIONS: Since there will be no reduction in nipple size during the post-operative period in AM patients, hypertrophic nipple can be reduced in the same session. However, in patients with AUM or RM, if the reduction in nipple size is not sufficient, it is more convenient to perform the nipple reduction operation 1-year post-surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .