Breast Implantation Rates in Israel: Is There a Change in Trend?

BACKGROUND: Breast implant illness (BII) is a rising concern among many patients. Although not fully understood, a connection between silicone breast implants and systemic diseases may be present. This connection may influence the types of breast surgeries performed. OBJECTIVES: To evaluate changing trends in breast surgeries in Israel over time, with regard to implantation, explantation, and implant exchange surgeries. METHODS: In this ecological study, we presented data from four private medical centers in Israel regarding the number of breast implant surgeries performed in the years 2018-2019. Data were collected bi-yearly. The types of surgeries included breast implantation, explantation, and breast implant exchange. RESULTS: When we summed and compared the yearly data, we saw that the number of implantations in 2018 was 2267 (80.1% of breast implant procedures that year), and 1929 (68.9%) in 2019. The number of implant exchanges in 2018 and 2019 was 482 (17.0%) and 608 (21.7%), respectively. In 2018, 80 (2.8%) explantations were performed and 262 (9.4%) in 2019. CONCLUSIONS: There appears to be a trend in the rise of implant removal surgeries in addition to a decrease in breast implantations. One possible reason may be patient concerns of BII. Another reason may be the increased public interest and discussion about systemic effects of breast implants. More research is needed in this field to achieve better understanding of the phenomenon, the reasons behind it, and the possible solutions and ways of treatment.

Implant Shell Characteristics: The Science Behind the Surface.

Modern breast implant design emphasizes the host response at the surface. Implant surfaces are characterized by their roughness, surface area, and potential for bacterial attachment. The future of implant design may lie in the ability of bioengineers to transform both the structure and chemical properties of the device surface and therefore affect potential long-term outcomes.

Tendencia en el uso de implantes mamarios de los cirujanos plásticos iberolatinoamericanos. Estudio FILACP 2010-2020 / Trend in the use of breast implants of iberolatin american plastic surgeons. FILACP study 2010-2020

INTRODUCCIÓN Y OBJETIVO: Desde su creación en 2010, el Comité de Registro de Implantes de la FILACP (Federación Ibero Latinoamericana de Cirugía Plástica), entidad internacional que agrupa a los 22 Sociedades Nacionales de Cirugía Plástica de habla hispana y portuguesa, ha trabajando para conocer las preferencias y usos habituales entre sus miembros en la cirugía de aumento mamario con implantes. Con ese objetivo, realizó entre 2010 y 2020 una serie de encuestas periódicas para investigar las variables implicadas en la cirugía mamaria con implantes llevada a cabo por los cirujanos plásticos de Ibero Latinoamérica y la forma en que pudiera haber influido en ellos la incidencia del linfoma anaplásico de células grandes asociado a implantes mamarios (LACG-AIM) y su posible relación etiopatogénica con determinados tipos de implantes. Presentamos en este artículo los datos obtenidos y analizamos las tendencias observadas. MATERIAL Y MÉTODO: Estudio comparativo de datos recogidos en 4 encuestas enviadas a 5000 miembros de la FILACP: la primera presentada en 2012, con 25 preguntas sobre cirugía mamaria primaria con implantes y 18 sobre cirugía secundaria; la segunda presentada en 2016 con 31 preguntas sobre cirugía primaria y 52 sobre cirugía secundaria; la tercera en 2018 con 40 preguntas tanto de cirugía primaria como secundaria; y la cuarta en 2020, con 13 preguntas generales. RESULTADOS: Los datos recogidos reflejan una preferencia de los cirujanos plásticos iberolatinoamericanos por el uso de implantes redondos, con tendencia al incremento del uso de los de cubierta lisa frente a los texturizados, con abordaje quirúrgico preferencial por vía periareolar, colocación en plano submuscular, y una concienciación creciente de la necesidad de realizar capsulectomía quirúrgica en las cirugías secundarias y del envío de la cápsula extirpada a estudio anatomopatológico. Refieren también un buen conocimiento del LACG-AIM y de las variables implicadas en su diagnóstico y tratamiento. Recogemos también a fecha abril de 2020 los casos de LACG-AIM notificados por las Sociedades Nacionales de la FILACP: 106 casos en 9 países, con 2 fallecimientos. CONCLUSIONES: La tendencia entre nuestros encuestados, seguramente influidos por el conocimiento de los factores relacionados con la etiología del LACG-AIM, va hacia el uso cada vez más mayoritario de implantes de cubierta lisa y de forma redonda, y representa una estimación importante y actualizada de los usos de un colectivo profesional muy representativo en un entorno internacional que suele recoger solo datos de profesionales y publicaciones anglosajonas

BACKGRAUND AND OBJECTIVE: Since its creation in 2010, the Implant Registry Committee of FILACP (Iberolatinoamerican Federation of Plastic Surgery) an international entity that gathers the 22 National Societies of Plastic Surgery of Spanish and Portuguese language, has worked to know the common preferences and uses among its members in breast augmentation surgery with implants. With this aim, between 2010 and 2020, it carried out a series of periodic surveys to investigate the variables involved in breast surgery with implants carried out by plastic surgeons from Iberolatinamerica and how the incidence of breast implants associated anaplastic large cell lymphoma (BIA-ALCL) and its possible etiopathogenic relationship with certain types of implants might have influenced them. We present in this article the data obtained and analyze the observed trends. METHODS: Comparative study of data collected in 4 surveys sent to 5000 FILACP members: the first one presented in 2012, with 25 questions on primary breast surgery with implants and 18 on secondary surgery; the second one presented in 2016 with 31 questions on primary surgery and 52 on secondary surgery; the third one in 2018 with 40 questions on both primary and secondary surgery; and the fourth one in 2020, with 13 general questions. RESULTS: General data reflects a preference of Iberolatinamerican plastic surgeons for the use of round implants, with a tendency to increase the use of smooth cover versus textured implants, with a preferential surgical periareolar approach, submuscular placement, and awareness growing need for surgical capsulectomy in secondary surgeries, and for the pathology study of the removed capsule. They also report a good knowledge of BIA-ALCL and the variables involved in its diagnosis and treatment. As of April 2020, we also collected the cases of LACG-AIM reported by the FILACP National Societies: 106 cases in 9 countries, with 2 deaths. CONCLUSIONS: The trend among our respondents, surely influenced by the knowledge of the factors related to the etiology of BIA-ALCL, is towards the increasing use of smooth and round-shaped implants, and represents an important and updated estimate of the uses of a highly representative professional collective in an international environment that usually collects only data from anglo-saxon professionals and publications

Changing Trends in Mastectomy and Breast Reconstruction. Analysis of a Single-institution Experience Between 2004-2016.

BACKGROUND/AIM: Recently, "conservative" mastectomy with immediate breast reconstruction (M-R) has become the gold standard when the breast must be removed. We analyzed the evolution in the choice of mastectomy type in our Unit, focusing on factors associated with renounce to reconstruction and risk factors for its failure. PATIENTS AND METHODS: Clinical-pathological and surgical features of 132 patients who underwent mastectomy in our Unit from 2004 to 2016 were analyzed. M-R rate and different mastectomy techniques' rates between 2004-2009 and 2010-2016 were compared. RESULTS: M-R was associated with younger age at diagnosis (p<0.001) and early tumor stage (p=0.03). M-R rate increased from 49.1% to 72.2% (p=0.002) in the last years, with prominent use of nipple-sparing-mastectomy (p<0.001). M-R failure rate was associated with previous or subsequent irradiation/chemotherapy in 92.3% of cases. CONCLUSION: M-R and particularly nipple-sparing-mastectomy represented the standard in more recent years; reconstruction failure was associated with irradiation/chemotherapy, especially in implant-based reconstructions.

10-Year Experience Using Inspira Implants: A Review with Personal Anecdote.

The article summarizes the author's experience with Inspira implants. They were first introduced into the European market in 2006. The advent of the Inspira range heralded a fundamental change in the way round implants were perceived. The comprehensive matrix, the form stability of the gels, along with sophisticated manufacturing of the shell placed them as a premium product for use in both aesthetic and reconstructive breast surgery. The same principles of precise tissue-based planning, developed for anatomical implants, were being adopted for use with Inspira, leading to more predictable outcomes with high levels of patient satisfaction.

Current Trends in Breast Augmentation: Analysis of 2011-2015 Maintenance of Certification (MOC) Tracer Data.

BACKGROUND: Breast augmentation is the most common aesthetic surgery performed in the United States. Despite its popularity, there is no consensus on many aspects of the procedure. OBJECTIVES: The authors assessed current trends and changes in breast augmentation from January 1, 2011 to December 31, 2015. METHODS: A retrospective cross-sectional study of 11,756 women who underwent breast augmentation based on the American Board of Plastic Surgery (ABPS) Maintenance of Certification Tracer Database was performed. RESULTS: There were clearly dominant trends in how ABPS-certified plastic surgeons performed breast augmentations. Most surgeries were performed in freestanding outpatient (47.3%) or office operating room (33.7%). The inframammary fold incision was most popular (75.1%), followed by periareolar (17.8%) and transaxillary approaches (4.1%). Implants were more commonly placed in a submuscular pocket (30.6%) compared with dual plane (26.7%) or subglandular (6.7%). Silicone implants (66.8%) were favored over saline (25.1%), with a statistically significant increase in silicone prostheses from 2011 to 2015. Data were "not applicable" or "other" in the remainder of cases. Administration of both preoperative antibiotics (3.8% in 2011, 98.7% in 2015, P < 0.05) and deep venous thromboembolism (DVT) prophylaxis (3.8% in 2011, 90.6% in 2015, P < 0.05) dramatically increased during the study period. Overall adverse events (7.4%) and reoperation rates (2.2%) were low. CONCLUSIONS: Changes in standard of care for breast augmentation are reflected by the evolving practice patterns of plastic surgeons. This is best evidenced by the dramatic increase in use of antibiotic and DVT prophylaxis from 2011 to 2015.

Evolving Trends in Textured Implant Use for Cosmetic Augmentation in the United States.

BACKGROUND: Breast implants have evolved for decades. In 2011, the U.S. Food and Drug Administration identified an association between textured breast implants and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The purpose of this study was to identify the trends of textured implant use since that time. METHODS: Maintenance of Certification tracer data were queried between 2011 and 2015 for cosmetic breast augmentation cases submitted by American Board of Plastic Surgery diplomates. A nested random effects logistic regression analysis was used to identify associations between variables. RESULTS: Eleven thousand seven hundred sixteen breast augmentations were performed by 880 unique surgeons. The overall proportion of cases using textured implants increased steadily from 2.3 percent in 2011 to 13.0 percent in 2015 (p < 0.001). The proportion of surgeons whose cases included both textured and smooth implants increased (from 6.2 percent to 24.3 percent), as did those using only textured implants (from 0.4 percent to 4.4 percent) (p < 0.001). Significance remained after controlling for form-stable implants, suggesting an alternative motivation for use of textured implants. Subglandular cases (20.5 percent) were more likely to use a textured implant than submuscular (8.4 percent) or dual-plane (7.8 percent) (p < 0.001) cases. CONCLUSIONS: Maintenance of Certification tracer data represent a random sampling of American Board of Plastic Surgery-certified plastic surgeons spanning the gamut of practice settings. Despite ongoing education regarding the association of BIA-ALCL with textured implants, American Board of Plastic Surgery diplomates have trended toward increased use of textured implants for cosmetic breast augmentation since 2011. This finding does not appear to be driven by the introduction of anatomical implants during the study period.

Public Interest in Breast Augmentation: Analysis and Implications of Google Trends Data.

INTRODUCTION: Breast augmentation is the most common aesthetic surgery performed in the United States (US) annually. Analysis of Google Trends (GT) data may give plastic surgeons useful information regarding worldwide, national, and regional interest for breast augmentation and other commonly performed aesthetic surgeries. METHODS: Data were collected using GT for breast augmentation and associated search terms from January 2004 to May 2017. Case volume was obtained from the American Society of Plastic Surgeons (ASPS) annual reports for the calendar year 2005-2016. RESULTS: Trend analysis showed that total search term volume for breast augmentation and breast implants gradually decreased worldwide and in the US over the study period while the search term boob job slowly increased. Univariate linear regression demonstrated a statistically significant positive correlation between average annual Google search volume of "breast augmentation" and the annual volume of breast augmentations performed in the US according to ASPS data (R 2 = 0.44, p = 0.018). There was no significant correlation between national volume of breast augmentations performed and search volume using the terms "breast implants" or "boob job" over time (p = 0.84 and p = 0.07, respectively). In addition, there appears to be country specific variation in interest based on time of year and peaks in interest following specific policies. CONCLUSIONS: To our knowledge, this is the first and only analysis of GT data in the plastic surgery literature to date. To that end, this study highlights this large and potentially powerful data set for plastic surgeons both in the US and around 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 .

Current Trends in Breast Augmentation: An International Analysis.

BACKGROUND: Breast augmentation surgery remains the most frequently performed aesthetic surgical procedure worldwide. However, many variations exist regarding preoperative planning, surgical management, and postoperative care. OBJECTIVES: The goal was to evaluate current trends and practices in breast augmentation, with a focus on international variability. METHODS: A questionnaire was sent to over 5000 active breast surgeons in 44 countries worldwide. The survey inquired about current controversies, new technologies, common practices, secondary procedures, and surgeon demographics. The findings and variations were evaluated and correlated to evidence-based literature. RESULTS: There were a total 628 respondents equaling a response rate of approximately 18%. While certain approaches and common practices prevail also on an international basis, there exist several geographic controversies. For example, while almost fifty percent of surgeons in the United States and Latin America never use anatomically shaped implants, in Europe and Oceania most surgeons use them. Similarly, in Latin America, Europe, Asia, and Oceania, over 80% of surgeons use silicone implants only, whereas in the United States only 20% use them - meanwhile US surgeons use the largest implants (78% > 300 cc). Internationally dominant practice preferences include preoperative sizing with silicone implants, as well as the use of inframammary incisions and partial submuscular pockets. CONCLUSIONS: Significant differences exist when comparing most common surgical breast augmentation approaches on an international basis. While certain techniques seem to be universal standards, there still remain several controversies. Further standardizing this most common aesthetic surgical procedure according to evidence-based guidelines will help to improve outcomes.

Trends in breast cancer surgery at Brazil's public health system.

BACKGROUND AND OBJECTIVES: To analyze time trend patterns in Breast Cancer (BC) surgeries performed at Brazil's Public Health System, known as SUS from 2008 to 2014. METHODS: Ecological study of time series, based on the database system from SUS. Information on surgical procedures performed for BC treatment was collected. Analysis of the absolute number of surgeries was performed using Poisson Regression through Jointpoint Regression, and the trends were calculated through the annual percentage change (APC), with a confidence interval (CI) of 95%, and statistical significance when P < 0.05. RESULTS: Data analysis from 193.596 breast surgeries revealed a reduced number of simple mastectomies (APC -4.4%; CI -7.4 to -1.4; P < 0.05); stable trends in radical mastectomy with lymphadenectomy (APC -1.0%; CI -2.4 to 0.5; P = 0.1) and breast conserving surgery (APC 0.4%; CI -1.6 to 2.4; P = 0.6). Also, we observed a reduced number of axillary lymphadenectomy dissection (APC -16.8%; CI -26.8 to -5.4; P < 0.05); increased trends in breast reconstruction with implants after 2011 (APC 9.1%; CI 0.1-18.8; P < 0.05) and with flaps after 2012 (APC 61.3%; CI 41.3-84.0; P < 0.05). The overall rate of patients with breast reconstruction increased from 15% in 2008 to 29.2% in 2014. CONCLUSIONS: We found a significant increase in breast reconstruction in public health system in Brazil, and also a reduction in simple mastectomy and axillary lymphadenectomy.

Anestesia general en paciente con síndrome de Poland / General anesthesia in patients with syndrome of Poland

El aumento del uso de la cirugía, como tratamiento o como alternativa de mejora, hace que nos encontremos en quirófano con un mayor número de pacientes, entre ellos los que adolecen de enfermedades poco comunes. El síndrome de Poland es una enfermedad congénita rara, relacionada con el desarrollo muscular. Estos pacientes pueden presentar un amplio espectro de anomalías, entre las que destacan: anomalías a nivel torácico, que pueden alterar el manejo ventilatorio, a nivel de la vía aérea; la posible aparición de una hipertermia maligna. Esto lleva al anestesiólogo a tomar ciertas medidas preventivas. Narramos el caso de una paciente con síndrome de Poland que se intervenía para colocación de una prótesis mamaria, en el que evitamos los halogenados, y llevamos a cabo una anestesia total intravenosa con propofol. La aparición de espasmos musculares consecuencia del uso del propofol obligó en una segunda anestesia a llevar a cabo una anestesia total intravenosa con midazolam (AU)

The increased use of surgery as a treatment or as an alternative for improvement means that we have a larger number of patients in the operating theatre, including those who suffer from rare diseases. Poland Syndrome is a rare congenital disease associated with muscle development. These patients may have a broad spectrum of abnormalities, which include thoracic anomalies, which can alter the ventilatory management at the level of the airway; the possible onset of malignant hyperthermia. This leads the anaesthetist to take certain preventive measures. We report the case of a patient with Poland syndrome operated for the placement of a breast prosthesis. We avoid halogenated agents, and use a Total Intravenous Anaesthesia with propofol. The appearance of muscle spasms as a result of the use of propofol, forced us into a second anaesthesia to perform total intravenous anaesthesia with Midazolam (AU)

What is new in the surgical management and prevention of breast cancer?

Breast cancer is the most common malignancy in Australian women. As most women now survive breast cancer, improving quality-of-life outcomes is increasingly important and major changes are occurring in breast surgery to meet this challenge. Use of neoadjuvant chemotherapy results in lower mastectomy rates, broader surgical options and less surgical morbidity. Oncoplastic breast surgery (OBS) facilitates less frequent need for mastectomy, better aesthetic outcomes and improved quality of life. Immediate breast reconstruction (IBR) improves quality of life and can be considered in a large proportion of women requiring mastectomy; however, Australia's rate of IBR is low compared with similar countries. Breast cancer risk reduction can be achieved with lifestyle modifications and, in women at high risk, chemoprevention with selective oestrogen receptor modulators or aromatase inhibitors. Bilateral prophylactic mastectomy is an option for BRCA gene mutation carriers or those women otherwise established to have a high level of risk. Contralateral prophylactic mastectomy (CPM) is increasingly performed at the time of initial breast cancer management, largely driven by patient preference. However, CPM does not improve survival and has similar rates of complications as therapeutic mastectomy. It should be cautiously considered, with full discussion of risks and benefits. Breast Surgeons of Australia and New Zealand (BreastSurgANZ) coordinates training of most new breast surgeons and is fostering a broader range of multidisciplinary oncology, OBS and IBR skills in its members. The BreastSurgANZ Quality Audit monitors the quality of care provided by members. Training breast surgeons now have access to a Graduate Certificate in Surgery (Breast Surgery) to broaden their knowledge base.

Estudio comparativo del uso de implante mamario únicamente o implante y malla biológica en reconstrucción inmediata tras mastectomía ahorradora de piel / Comparative study of the use of immediate implant-based breast reconstruction with or without biological dermal mesh after skin-sparing mastectomy

Objetivo. Valorar las complicaciones postoperatorias en pacientes intervenidas mediante mastectomía ahorradora de piel o piel y aréola-pezón, con reconstrucción inmediata e implantación de prótesis o prótesis más malla biológica. Pacientes y métodos. Estudio prospectivo. Periodo de estudio: octubre de 2011-octubre de 2014. Criterios de inclusión: cáncer de mama multicéntrico, carcinoma ductal in situ con indicación de mastectomía y tumores cT2 que no tuvieron respuesta a tratamiento sistémico primario. Criterios de exclusión: edad > 75 años. Grupo control: pacientes reconstruidas mediante prótesis. Grupo estudio: pacientes reconstruidas mediante prótesis y malla biológica de dermis porcina acelular, no entrecruzada, de 1,6 mm e hidratada. Resultados. Se incluyeron en el grupo de estudio 34 pacientes, y en el grupo control, 38 pacientes. Extrusión de prótesis: grupo estudio uno (2,9%); grupo control 9 (23,7%) (p = 0,015). Infecciones: grupo estudio 3 (8,8%); grupo control 3 (7,9%) (p = 1). Necrosis cutánea: grupo estudio 5 (14,7%); grupo control 5 (13,2%) (p = 1). Seroma: grupo estudio 5 (14,7%); grupo control 5 (13,2%) (p = 1). Conclusión. Se ha observado una disminución significativa de la extrusión de la prótesis en las mujeres en las que se implantaron mallas biológicas. En seromas, infección y necrosis cutánea no observamos diferencias significativas (AU)

Objective. To evaluate postoperative complications after skin- or nipple-sparing mastectomy with immediate implant-based breast reconstruction with or without biological dermal mesh. Patients and methods. Prospective study. Study period: October 2011-October 2014. Inclusion criteria: multicentre breast cancer, ductal carcinoma in situ with indication for mastectomy, and cT2 tumours with no response to primary systemic treatment. Exclusion criteria: patients older than 75 years. Control group: breast reconstructions with mammary prosthesis exclusively. Study group: breast reconstructions with implant and non-crosslinked biological 1.6 mm hydrated acellular porcine dermal mesh. Results. Thirty-four patients were included in the treatment group and 38 patients in the control group. Number of prosthesis extrusions: study group one (2.9%); control group 9 (23.7%) (P = .015). Infections: study group 3 (8.8%); control group 3 (7.9%) (P = 1). Skin necrosis: study group 5 (14.7%); control group 5 (13.2%) (P = 1). Seroma: study group 5 (14.7%); control group 5 (13.2%) (P = 1). Conclusion. The number of extrusions was significantly lower in breast reconstructions with prosthesis and biological mesh. No significant differences were observed in seroma, infection, or skin necrosis (AU)

Revisión a 5 años de técnicas quirúrgicas y características de los implantes en 2876 mamoplastias de aumento consecutivas / A 5-year review of surgical techniques and implant characteristics in 2876 consecutive augmentation mammaplasties

El objetivo del presente trabajo es estudiar las técnicas quirúrgicas en mamoplastia de aumento y los tipos de prótesis (material, superficie, volumen) empleadas en los últimos años por nuestro grupo de Cirugía Plástica Ambulatoria del Centro Médico Platinum en Caracas, Venezuela, revisando para ello retrospectivamente2876 mamoplastias de aumento y aumentopexias consecutivas, realizadas en los últimos 5 años. La edad promedio de las pacientes del grupo de estudio fue30,8 años (71% menores de 35 años). En todas empleamos prótesis rellenas de gel de silicona, redondas, 86% de superficie lisa y 77% de perfil alto. El 97% se colocaron en el plano retropectoral. El volumen promedio fue de 386 cc para la mama derecha y de 387 cc para la mama izquierda (mínimo de 200 cc y máximo de600cc). Hubo una relación inversa entre edad y volumen(p = 0,001). En cuanto al volumen utilizado, el comportamiento fue homogéneo entre los 27 cirujanos plásticos del centro. Perthese® y La Femme®, fueron las marcas más empleadas. El uso de perfiles extra-altos aumentó en los últimos años (p = 0,002).En poco más de la mitad (51%) de las pacientes, se combinó el aumento mamario con una pexia. En el 13% la cirugía mamaria se combinó con otro procedimiento quirúrgico. Las mamoplastias de aumento predominaron en menores de 35 años, y las aumentopexias en las pacientes de mayor edad. En conclusión, comprobamos que en nuestro medio se utilizan mayoritariamente prótesis rellenas de gel de silicona, redondas, lisas, de perfil alto, colocadas en un plano retropectoral. En pacientes de mayor edad se combinó el aumento mamario con lapexia y se utilizaron tamaños de prótesis más pequeñas. En los últimos años ha aumentado el uso de prótesis de perfil extra-alto (AU)

We conducted a study to evaluate the breast augmentation techniques and type of implants (material, surface, volume) in the last years in our group of Day Unit Plastic Surgery at Centro Médico Platinum in Caracas, Venezuela. We retrospectively review2876 consecutive augmentation mammoplasties and augmentation-mastopexies, performed in the last 5 years. The average age of the patients was 30,8 years (71% under 35years). All the implants were silicone gel filled prosthesis, round,86% smooth surface and 77% high profile; 97% were placed in the subpectoral plane. The average volume was 386 cc for the right breast, and 387 cc for the left breast (minimum 200 cc and maximum.600 cc). There was an inverse relationship between age and volume (p = 0.001). As for the volume used, the behavior was homogeneous among the 27 plastic surgeons of the group. Perthese® and La Femme® were the most used brands. The use of extra-high profiles increased in recent years (p = 0,002).In just over half (51%) patients, mammary augmentation was combined with a mastopexy. In 13% breast surgery was combined with another surgical procedure. The augmentation mammoplasty predominated in patients under 35 years, and augmentation mastopexies in the older ones. In conclusion, we comprobed that in our area, silicone gel-filled, smooth surface, high profile mammary implants are mostly used, placed on a retropectoral plane. In older patients, breast augmentation is combined with mastopexies and smaller sizes are used. In recent years use of extra-high profile implants is increasing (AU)

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Diminishing relative contraindications for immediate breast reconstruction.

BACKGROUND: The rise in U.S. immediate breast reconstruction over the past decade may reflect greater patient awareness or expanding use in women not previously offered reconstruction. The purpose of the current study was to determine whether reconstruction in high-risk surgical and oncologic patients was a factor contributing to increased reconstruction rates, specifically using prosthetic techniques. METHODS: Information from a cohort of mastectomy patients from 2001 to 2012 was extracted from an institutional database, including the presence of high-risk surgical or oncologic features (age over 60 years old, body mass index greater than 30, comorbidities, smoking, advanced disease, and prior or postmastectomy radiotherapy). Trends in reconstruction rates and method were analyzed with Poisson regression. Reconstructive success was defined as tissue expander exchange to a permanent implant or autologous techniques without vascular complications. RESULTS: A total of 10,299 patients were included. Immediate reconstruction in high-risk patients increased from 45.0 to 70.7 of 100 mastectomies (p < 0.01). Although autologous use increased only for obese patients (p < 0.01), prosthetic techniques were greater for all high-risk features (p < 0.01). Reconstructive success was 88 percent in high-risk patients; however, the number of failures was greater, including tissue expander loss, implant explantation, and flap vascular complications. CONCLUSIONS: The proportion of high-risk patients undergoing immediate breast reconstruction-specifically using prosthetic-based techniques-increased over the study period. Increased complications may be a tradeoff for the benefits of reconstruction. These findings support diminishing relative contraindications for immediate breast reconstruction at a tertiary cancer center. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.