Search

The B-Lite® lightweight breast implant (LWBI) weighs ~ 30% less than traditional silicone implants for a given volume. Since weight is a persistent and unrelenting stress on the soft breast tissues, a lightweight implant is expected to reduce complications, particularly in challenging cases where there is very thin or ‘at risk’ breast tissue. The study determined the clinical outcomes of women who underwent B-Lite implantation surgery following mastectomy or massive weight loss (MWL) after bariatric surgery. Retrospective review of all cases from January 2017 to June 2018. Candidates underwent standard surgical procedures with the LWBI, either one-stage implantation DTI or two-stage implantation, with surgical mesh or fat grafting. Eleven women (8 following mastectomy and 3 following MWL) aged 47.5 ± 9.1 years with a BMI of 20 ± 1.4 underwent the procedures with a total of 15 implants. At one-month follow-up, complications were rare with no adverse events including no cases of infection, hematoma, seroma or red breast syndrome. The only complications involved two cases who developed necrosis that was clearly related to the mastectomy. The necrosis was consequently, conservatively treated with local debridement. The current follow-up duration is 26 ± 7 months (21–31) with no further complications noted and excellent clinical outcomes. The cosmetic result is exceptional with minimal scarring from the vertical incision. The B-Lite results are preliminary but suggest a safety profile similar or better than traditional implants with a promising benefit in challenging cases. Level of evidence: Level IV, therapeutic study.

Redefinition of the inframammary fold in post-mastectomy reconstruction is an essential element to achieve construction of a natural-looking breast, either using implants and autologous tissue. Over years many techniques have been described scheduling external surgical approach (through incisions being made directly on the fold) or internal surgical approach (through the scar of previous procedure for breast expander positioning) and using running sutures or suture with interrupted stitches. A modified technique for redefinition of the inframammary fold using an internal approach was performed in 130 breast reconstruction procedures. Cosmetic outcomes and stability over time were assesed. No total collapse was observed. The outcomes were classified as very good 65.3% patients, satisfactory 23% and poor in 9.2%. The accumulative risk for definition loss of the reconstructed fold was 11% in eight years. The technique presented in this article is a modification of already reported techniques and is easy and fast to perform, it adds no external scars so ensuring at the same time, natural inframammary fold definition and good reproduction of ptosis in medium to large breasts. Level IV, therapeutic study.

Today, immediate breast reconstruction is widely accepted in breast cancer surgery. There are many reconstruction procedures that combine cancer indications with patient's expectations. Improved techniques in the use of textured or polyurethane-coated implants and tissue expanders, associated with increasingly more conservative mastectomy procedures, may result in better cosmetic outcomes and less complications, even in patients that require postoperative radiotherapy. From June 2002 to December 2008, 166 unilateral breast reconstructions were performed immediately using definite prosthesis with polyurethane-coated (6) or textured (24) implants, or later, after implant of 136 tissue expanders, using polyurethane-coated (113) or textured (23) implants. Eighty-six two-stage breast reconstructions were irradiated where later 63 polyurethane-coated implants and 23 textured implants have been inserted. Results were analysed evaluating complications associated with temporary expanders and with the two definite implants, with or without RT, respectively. Excluding capsular contracture, total complication rate was 14.7% with expanders, 5.0% with polyurethane implants and 12.8% with textured implants. In this study, severe capsular contracture was reported in 21.7% of cases with textured prosthesis and in 6.3% of cases with polyurethane implants in patients receiving RT. This difference was statistically significant. As of today, no case of clinically noticeable capsular contracture was seen in non-irradiated patients receiving breast reconstruction with polyurethane-coated implants. These results allow us to establish RT, which is not a severe contraindication to breast reconstruction with implants. Polyurethane implants have provided encouraging results either in terms of lower complication rate and likelihood of capsular contracture.