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Researches of Breast Surgery

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Progressive spontaneous unilateral enlargement of the breast twenty-two years after prosthetic breast augmentation

Author: S. Roman, D. Perkins*
Department of Plastic and Reconstructive Surgery, St George Hospital, Gray Street, Kogarah, Sydney, Australia
Abstract:

Late spontaneous enlargement of the breast is a rare complication after prosthetic breast augmentation. It has been intermittently described in the literature over the last 24 years but its exact aetiology remains unknown. Several possible
aetiologies have been proposed. We present a case of a 46-year-old female who developed spontaneous asymmetrical breast enlargement 22 years post-bilateral breast augmentation without any known precipitating factors. Radiographic imaging revealed a periprosthetic collection occupying 70% of the volume inside the capsule.

Initial recommendations for capsulectomy and removal of the breast implant were delayed for a year by the patient who subsequently represented with ongoing enlargement of the affected breast. Pathological findings revealed an intact silicone implant surrounded by laminated blood clot, similar in appearance to a chronic subdural haematoma. The literature is reviewed and the possible pathophysiological mechanisms of this unusual condition discussed.

Published : 20 April 2004
Keywords: Late periprostheti; haematoma; Silicone; implant; Asymmetrical; breast swelling; Augmentation; mammaplasty

Mammaplasty With L-Incision

Authors: Carlos Inacio Coelho de Almeida, MD
From the Division of Plastic Surgery, Julia Kubistchek Hospital FHEMIG, Belo Horizonte, Brazil.
Dr. Coelho de Almaeda is a member of the Brazilian Society of Plastic Surgery.
Abstract:

Background: The cutaneous sequelae resulting from mastopexy and reduction mammaplasty are serious drawbacks for patients, particularly young women, and physicians who are dissatisfied with extensive postoperative scarring. Objective: The author reports on an L-incision technique that involves a base resection with an upper transposition of the nipple-areolar complex (NAC) to yield good shape and projection, short scars, and preservation of lactation.

Methods: Preoperative markings were made to aid estimation of the amount of breast tissue to be excised, to establish anatomic landmarks ensuring breast symmetry, and to position the scars. Breast reduction was performed by means of perpendicular excision of the lower pole and transverse amputation of the base from the pectoral aspect of the breast. In wider breasts, a vertical keel was excised to decrease the circumference of the base. In mastopexy, the lower pole was preserved as a superiorly based flap and used to fill the upper pole. The new site of the NAC was marked bilaterally, slightly lower than the apex of the new mammary cone, with the downward rotation of the breast during the early postoperative period taken into consideration.

Results: The described L-incision procedure was performed in more than 500 patients between 1996 and 2003, with good results and a low rate of complications. Nipple sensitivity was generally preserved unless lesions of the lateral branches of the intercostal nerves were present. No lactation problems were reported by the 9 patients who breastfed babies after undergoing surgery. Twenty-seven patients underwent revision procedures to correct scar hypertrophy, areolar enlargement, asymmetry, persistent ptosis, or correction of "dog-ear.

Conclusions: The L-incision technique is a safe, reliable procedure that results in good breast shape and projection with inconspicuous scars. It can be used in a wide variety of applications, including correction of breast hypertrophy, ptosis, and asymmetries.

Published: 2004
Keywords: Breast Surgery
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