Immediate Direct-To-Implant Breast Reconstruction Using Anatomical Implants

Kim, Sung-Eun,Jung, Dong-Woo,Chung, Kyu-Jin,Lee, Jun Ho,Kim, Tae Gon,Kim, Yong-Ha,Lee, Soo Jung,Kang, Su Hwan,Choi, Jung Eun Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.5

Background In 2012, a new anatomic breast implant of form-stable silicone gel was introduced onto the Korean market. The intended use of this implant is in the area of aesthetic breast surgery, and many reports are promising. Thus far, however, there have been no reports on the use of this implant for breast reconstruction in Korea. We used this breast implant in breast reconstruction surgery and report our early experience. Methods From November 2012 to April 2013, the Natrelle Style 410 form-stable anatomically shaped cohesive silicone gel-filled breast implant was used in 31 breasts of 30 patients for implant breast reconstruction with an acellular dermal matrix. Patients were treated with skin-sparing mastectomies followed by immediate breast reconstruction. Results The mean breast resection volume was 240 mL (range, 83-540 mL). The mean size of the breast implants was 217 mL (range, 125-395 mL). Breast shape outcomes were considered acceptable. Infection and skin thinning occurred in one patient each, and hematoma and seroma did not occur. Three cases of wound dehiscence occurred, one requiring surgical intervention, while the others healed with conservative treatment in one month. Rippling did not occur. So far, complications such as capsular contracture and malrotation of breast implant have not yet arisen. Conclusions By using anatomic breast implants in breast reconstruction, we achieved satisfactory results with aesthetics better than those obtained with round breast implants. Therefore, we concluded that the anatomical implant is suitable for breast reconstruction.

Complications Including Capsular Contracture in Direct-to-Implant Breast Reconstruction With Textured Anatomical Versus Smooth Round Implants: A Single Center Retrospective Analysis

전홍배,이민영,노태석,정준,안성귀,배숭준,이나라,김영석 한국유방암학회 2023 Journal of breast cancer Vol.26 No.1

Purpose: Implant-based breast reconstruction is the most common reconstruction method used after mastectomy in breast cancer patients. Many studies have compared the smooth round implants and textured anatomical implants. This study aimed to compare the complications, including capsular contracture, between these two implants used in direct-to-implant (DTI) breast reconstruction. Methods: This retrospective chart review was performed using a prospectively maintained database from a single center. We identified patients who underwent mastectomy with DTI single-stage breast reconstruction at our hospital between August 2011 and June 2021. The overall complications, including capsular contracture, postoperative infection, seroma, hematoma, implant rupture, implant exposure, rippling, implant malposition, and nipple necrosis, were analyzed. Results: In total, 340 breasts of 323 patients were reconstructed by the DTI approach using either textured anatomical (n = 203) or smooth round (n = 137) implants. The incidence of overall complications and capsular contracture was significantly lower with smooth round implants than with textured anatomical implants. Multivariate analysis showed that smooth round implants were associated with a reduced risk of overall complications (odds ratio [OR], 0.465; 95% confidence interval [CI], 0.265–0.813) and capsular contracture (OR, 0.475; 95% CI, 0.235–0.962). Particularly, smooth round implants were associated with a decreased risk of overall complications in patients not receiving adjuvant chemotherapy and a decreased risk of capsular contracture in patients with body mass index < 25 kg/m2 and in those not receiving adjuvant radiotherapy. Conclusion: Smooth round implants demonstrated a decreased risk of overall complications and capsular contracture when compared with textured anatomical implants. These results may be utilized in counseling patients regarding the advantages and disadvantages of smooth round implants in DTI breast reconstruction.

A Comparison of Smooth and Microtextured Breast Implants in Breast Augmentation: A Retrospective Study

Joo Hyuck Lee 대한성형외과학회 2023 Archives of Plastic Surgery Vol.50 No.2

Background The number of cosmetic and reconstructive surgeries that use breast implants is increasing in Korea. Recently, it has been reported that breast implantassociated anaplastic large-cell lymphoma is related to textured breast implants, and interest in classification according to the texture of breast implants is increasing. However, there is currently no clear and unified classification. In particular, the definition of “microtextured” is highly varied. In this study, we retrospectively investigated and analyzed the clinical outcomes of smooth and microtextured breast implants. Methods A retrospective chart review of all patients who underwent breast augmentation surgery with smooth and microtextured silicone gel implants between January 2016 and July 2020 was performed. We retrospectively analyzed implant manufacturer, age, body mass index (BMI), smoking status, incision location, implant size, follow-up period, complications, and reoperation rate. Results A total of 266 patients underwent breast augmentation surgery, of which 181 used smooth silicone gel implants and 85 used microtextured silicone gel implants. Age, BMI, smoking status, implant size, and follow-up period were not significantly different between the two groups. Similarly, complications and reoperation rates were not significantly different between the two groups. Conclusion It is important to provide information regarding the clinical risks and benefits of breast implants to surgeons and patients through a clear and unified classification according to the texture of the breast implant.

Immediate Direct-To-Implant Breast Reconstruction Using Anatomical Implants

김성은,정동우,정규진,이준호,김태곤,김용하,이수정,강수환,최정은 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.5

Background: In 2012, a new anatomic breast implant of form-stable silicone gel wasintroduced onto the Korean market. The intended use of this implant is in the area ofaesthetic breast surgery, and many reports are promising. Thus far, however, there have beenno reports on the use of this implant for breast reconstruction in Korea. We used this breastimplant in breast reconstruction surgery and report our early experience. Methods: From November 2012 to April 2013, the Natrelle Style 410 form-stable anatomicallyshaped cohesive silicone gel-filled breast implant was used in 31 breasts of 30 patients forimplant breast reconstruction with an acellular dermal matrix. Patients were treated withskin-sparing mastectomies followed by immediate breast reconstruction. Results: The mean breast resection volume was 240 mL (range, 83–540 mL). The mean size ofthe breast implants was 217 mL (range, 125–395 mL). Breast shape outcomes were consideredacceptable. Infection and skin thinning occurred in one patient each, and hematoma andseroma did not occur. Three cases of wound dehiscence occurred, one requiring surgicalintervention, while the others healed with conservative treatment in one month. Rippling didnot occur. So far, complications such as capsular contracture and malrotation of breast implanthave not yet arisen. Conclusions: By using anatomic breast implants in breast reconstruction, we achievedsatisfactory results with aesthetics better than those obtained with round breast implants. Therefore, we concluded that the anatomical implant is suitable for breast reconstruction.

Patient Satisfaction with Implant Based Breast Reconstruction Associated with Implant Volume and Mastectomy Specimen Weight Ratio

백우열,변일환,김영석,유대현,정준,노태석 한국유방암학회 2017 Journal of breast cancer Vol.20 No.1

Purpose: Breast volume assessment is one of the most important steps during implant-based breast reconstruction because it is critical in selecting implant size. According to previous studies, there is a close relationship between the mastectomy specimen weight and resected breast volume. The aim of this study was to evaluate long-term patient satisfaction with implantbased breast reconstruction guided by the ratio of implant volume to mastectomy specimen weight. In doing so, we describe the ideal ratio for patient satisfaction. Methods: A total of 84 patients who underwent implant-based breast reconstruction for breast cancer were included in this study. The patients were grouped by the ratio of implant size to mastectomy specimen weight (group 1, <65%; group 2, 65%–75%; and group 3, >75%). Outcome analysis was performed using a questionnaire of patient satisfaction and the desired implant size. Results: Patient satisfaction scores concerning the postoperative body image, size, and position of the reconstructed breast were significantly higher in group 2. The average ratio of the ideal implant volume to mastectomy specimen weight for each group was 71.9% (range, 54.5%–96.7%), with the differences across the three groups being not significant (p=0.244). Conclusion: Since there is an increase in breast reconstruction, selecting the appropriate breast implant is undoubtedly important. Our novel technique using the ratio of implant volume to mastectomy specimen weight provides physicians a firm guide to intraoperative selection of the proper implant in reconstructive breast surgery.

A population-based study of breast implant illness

Magno-Padron, David A.,Luo, Jessica,Jessop, Terry C.,Garlick, Jared W.,Manum, Joanna S.,Carter, Gentry C.,Agarwal, Jayant P.,Kwok, Alvin C. Korean Society of Plastic and Reconstructive Surge 2021 Archives of Plastic Surgery Vol.48 No.4

Background Despite evidence supporting the safety of breast implants, some women associate their implants with adverse health effects and have called this syndrome "breast implant illness." We sought to characterize breast implant illness symptoms and to report how implant removal affects their symptoms. Methods An anonymous 20 question survey was administered to the Facebook group: "UTAH Breast Implant Illness" to characterize the symptoms these women attributed to their breast implants. Several questions allowed us to evaluate how implant removal affected women's symptoms. Results Of the 182 respondents, 97% report that implants negatively affect their health and 95% identify these symptoms with breast implant illness. Ninety-six percent of respondents had implants placed for cosmetic reasons and 51% had silicone implants. The most common symptoms associated with breast implant illness are brain fog (95%), fatigue (92%), joint pain (80%), and hair loss (74%). Sixty percent of respondents learned about breast implant illness from family/friends and/or social media platforms (56%), 40% of respondents had their implants removed, and 97% report relief of their symptoms post-removal (23% complete, 74% partial). Following explantation, there was a significant improvement in all but one reported symptom. An association was found between the number of symptoms reported prior to explantation and the number of symptoms resolving following explantation. Conclusions Breast implant illness is a syndrome characterized by fatigue, decreased focus, hair loss, and joint pain after the placement of breast implants. Nearly all patients report improvement of symptoms after implant removal. Significant efforts should be made to better understand breast implant illness and its etiology.

유방확대술 후 유방보형물의 파열 : 피막내외의 동시 파열에 대한 증례보고

구자혜,정성호 대한미용성형외과학회 2013 Archives of Aesthetic Plastic Surgery Vol.19 No.1

This paper presents the case of a ruptured hydrogel breast implant, along with its clinical, radiologic, and pathologic findings. Breast asymmetry is typically the most common clinical feature of breast implant rupture. In case of a hydrogel breast implant rupture, hydrogel spreads out after implant leakage and the breast is enlarged with swelling and edema. Intracapsular ruptures showed no significant collapse of the implants despite a collection of fluid surrounding the implant inside the capsule. However, extracapsular ruptures showed implant collapse and extensive inflammation or fibrosis extension to the muscle and chest wall. In this case, a large amount of fluid collection with enlarged implants inside the capsule and extracapsular granulomas were showed simultaneously. Since the use of silicone breast implants has been restricted,hydrogel implants have been used for some time as an alternative option for breast implants. However,hydrogel implants have been restricted because of their unpredictability and unreliability. This case report draws attention to an unusual presentation of complications following the insertion of hydrogel breast implants for augmentation mammoplasty.

유방재건술에 사용된 식염수 보형물의 임상적 내구성과 누출

김일국,이준호,김용하,김태곤,이수정,강수환 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.6

Purpose: Despite wide clinical use of breast implants,there is continued concern about the lifespan of these devices. The causes of explantation were infection,deflation of implant and patient's want. The deflation of saline-filled breast implant was related to strength and durability of implant shell. The purpose of this study is to evaluate the clinical durability of saline-filled breast implant through the analysis of duration until deflation occurred,causes, incidence and influencing factors. Methods: Retrospective analyses were conducted on clinical records for 19 cases of deflation of saline-filled breast implant from 201 cases of breast reconstruction with saline-filled implant between May 1995 and June 2011. The authors had been analyzed the causes of deflation,survival duration, symptom, sign, nipple excision,volume of implant, saline filling, method of reoperation,breast cancer stage and combined capsular contracture. Results: The causes of deflation were attributed to the cases that cannot be evaluated the causes in 15 cases, fall down in 1 case, mammography in 2 cases, accidental needle injury in 1 case. Mean survival duration was 4 years and 5 months. The duration of survival was less than 1 year for 5 cases, 1 year to 10 years for 10 cases, more than 10years for 4 cases. The volume between 201 and 250 cc of deflated breast implant was rated as high by 14.0 percent. The deflation rate of underfilled implants was 11.4 percent,adequate filled implants was 9.3 percent. None of overfilled implant was deflated. The deflation of smooth surface implant was 5 of 152 cases. Textured implant was 14 of 49cases. The capsular contracture of non-deflated breast implant was 28 of 182 cases and that of deflated breast implant was 6 of 19 cases. Conclusion: The patients who underwent saline-filled breast implant implantation should be informed that their implant could deflate. The analysis of clinical durability and causes of deflation in breast implant was important for the prediction and prevention of reopeation. The authors could suppose the causes of deflation of saline-filled breast implant through history, duration of survival, inspection of the shell of implant.

보형물을 이용한 즉시유방재건술에서 자연스러운 유방하수를 얻기 위한 근육하-피부하 공간의 이용

정재호,신승규,이준호,최재원 대한미용성형외과학회 2008 Archives of Aesthetic Plastic Surgery Vol.14 No.2

One-stage breast reconstruction with implant is the most popular method for the breast reconstruction. Since most of the implant is inserted into submuscular pocket, displacement of implant and loss of ptosis are inevitable, because of narrow space of submuscular pocket. Therefore, submuscular-subcutaneous pocket has been introduced to reproduce natural ptotic breast and we have experienced complication of "bottom-out" of implant. To prevent this complication, supportive surgical brassiere was applied. After subcutaneous mastectomy, the undermining of the pocket was submuscular in its upper part and subcutaneous in the lower part of the breast. The muscle was released inferiorly from the origin, and the detached pectoralis muscle was sutured to the subcutaneous tissue of skin flap. Supportive surgical brassiere postoperatively maintained for 3 months. From June of 2006 through May of 2007, 30 subcutaneous mastectomies combined with breast reconstruction were performed in 29 patients. The reconstructed breasts appeared satisfactorily ptotic. Nevertheless, there were short term complications such as infection (2 cases) and wound dehiscence (1 case). Capsular contracture occurred in 6 patients. We suggest the submuscular-subcutaneous pocket technique combined with postoperative supportive surgical brassiere as a simple and reliable method of breast reconstruction for realization of natural ptotic breast.

The Emerging Crisis of Stakeholders in Implant-based Augmentation Mammaplasty in Korea

김재홍,백남선,남상유,Younghye Cho,박흥규 대한의학회 2020 Journal of Korean medical science Vol.35 No.15

Background: Korea is no longer safe from the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL); the first reported case was a Korean woman in her 40s who had a 7-year-history of receiving an implant-based augmentation mammaplasty using a textured implant. We conducted this study to discuss the emerging crisis of stakeholders in implant-based augmentation mammaplasty and to propose a multi-disciplinary approach to early detection of its complications. Methods: We analyzed medical examination data that was collected from patients who visited us between August 12 and September 27, 2019. We evaluated a total of 114 women (n = 114) in the current study. They were evaluated for whether they were in healthy condition. Moreover, their baseline characteristics were also examined; these included age, gender, height (cm), weight (kg), duration since surgery (years), possession of a breast implant card, the site of surgical incision, side of symptoms and reasons for outpatient visit. Furthermore, the patients were also evaluated for their subjective awareness of the manufacturer, surface and shape of the breast implant. Potential complications include malrotation, folding, seroma, capsule thickening, upside-down rotation, rupture, capsule mass and breast mass. Results: A majority of the patients had a past history of receiving textured implants. The corresponding percentage was 78.95% (90/114) and 85.09% (97/114) based on their subjective awareness of a breast implant and sonographic findings, respectively. That is, it was slightly increased with the use of a breast ultrasound. Conclusion: Here, we propose the following approaches. First, patient data should be prospectively collected. By tracking outcomes and complications of an implant-based augmentation mammaplasty, both high-quality care and patient safety can be ensured. Second, stakeholders in implant-based augmentation mammaplasty should collaborate with customers and regulatory authorities. Third, surgeons should consider applying imaging modalities for early detection of postoperative complications.