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Introduction: personal appearance is a variable of great importance to understand the psychosocial sphere of the individual. Thanks to the development of Plastic Surgery, almost all the external elements of a person can be modified and an imperfection can be molded or transformed in relation to the subjective appreciation and conceptualization of beauty. The consensual decision to implant prostheses to solve breast defects is valued by medical ethics. In 2017, prosthetic implantology for aesthetic purposes was initiated in the hospital in patients with breast augmentation. Objective: to assess ethical aspects related to prosthetic plastic surgery in today's society and the impact of its outcome on the psychosocial function of patients. Method: in September 2020, a bibliographic review of the medical literature published in the last 18 years, in Spanish and English, was carried out. The Google Scholar search engine was used. Development: plastic surgery procedures modify personal appearance and directly increase the psychological and social wellbeing of patients; prosthetic implantology techniques imply immediate and relevant results. Conclusions: breast augmentation surgery with prostheses has a positive and immediate impact on patients' overall satisfaction and projects them to higher levels of personal and social performance with new reinforced self-image and positive aspirations. [ABSTRACT FROM AUTHOR]

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 review 2876 consecutive augmentation mammoplasties and augmentation-mastopexies, performed in the last 5 years. The average age of the patients was 30,8 years (71% under 35 years). 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 augmentationmastopexies 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. [ABSTRACT FROM AUTHOR]

Fat grafting has become one of the main tools in Plastic Surgery and as it could only be, the breast is the main target organ of our performance. Since we introduced the technique in our private practice in 2009 we have been increasing its use. The top three indications are: breast augmentation, correction of defects and asymmetries and more recently breast augmentation combining both techniques. Breast enhancement with fat is indicated for patients who want to increase the volume without using implants. It must be explained very well to the patient what we can achieve in terms of volume and projection of the breast, along with the potential problems of cysts and microcalcifications in mammograms. Adipose tissue is a great complement to the implants, and we can correct deformities and asymmetries that with implants are much more difficult to solve. Breast augmentation combining both techniques is the final result of the therapeutic evolution as we combine the advantages of both: the firmness and stable volume supported by the implants and the plasticity of the adipose tissue to achieve greater symmetry. [ABSTRACT FROM AUTHOR]

A series of 50 female patients that underwent transfer of fatty tissue as sole treatment for breast augmentation without previous expansion is presented in this work, with a follow up of 5 years checked from September 2004 through January 2012, ages ranging from 17 to 48 years. The donating sites, in order of importance were the supragluteal, trochanter and infraumbilical regions. The tissue was obtained by means of a 3 mm cannula and a fat aspirator working at a half atmosphere; the preparation of the fat consisted only of the decantation of Klein solution in excess and the elimination of the elastic fibers. Infiltration was performed with 3 mm spatula cannula laying 2 mm strands at different levels, i.e., intramuscular on the pectoralis major, subglandular and periglandular, until the desired volume was obtained. On the first trial were applied from 250 to 400 cc; on the second trials, leaving 2 or 3 months only in 8 cases when it was necessary, having an reabsorption that ranged from 10 to 15%. The breast augmentation remained stable during the follow up period, with the breast undergoing the normal drop due to gravity or when the patients gained or lost weight significantly. [ABSTRACT FROM AUTHOR]

The breast implant associated with mastopexy actually is one of most difficult plastic surgeries. In fact, it is a surgery where the surgeon has to use his higher capabilities and skills in order to decide with precision the best relationship between ideal sizes of the breast implant and skin excess. The purpose in this paper is to present a breast lateral and medial flaps technique for augmentation mastopexy surgery looking for a better breast design and resistance on the final result. The technique was created on breast circulation basis, skin excess and better definition and resistance about the aesthetical breast results in the augmentation mastopexy surgery utilizing the T scar technique. The early results were acceptable in order to get breast definition, breast structure and implant protection. The long term results, especially breast resistance, will need to be evaluated. In our opinion, the technique is easy to execute, it allows a satisfactory aesthetic result giving the perception of high security on the implant position, but its resistance in a long term view needs better evaluation. [ABSTRACT FROM AUTHOR]

The mammary structural fat graft offers news treatment options in breast augmentation cosmetic surgery, but it sometimes meets expectations and sometimes doesn't. We analyze 4 different types of lipostructure mammary applications that we have been using in the last years, focused in an important aspect of this surgery as it's the filling of the upper mammary pole. These applications are: mammary augmentation by simple structural fat compared with the use of mammary implants; structural fat graft and mastopexy versus implants and mastopexy; tuberous breast reconstruction using structural fat graft or implants and finally, periprosthetic filling in breast augmentation with mammary implants using structural fat graft. In short, we could summarize this paper telling that in our opinion, structural fat graft doesn't work if our intention is to fill the upper mammary pole. However, structural fat graft is not only an alternative; in some cases it exceeds the expected results using mammary implants. [ABSTRACT FROM AUTHOR]

Galactorrhea is a complication rarely observed after mammary plastic surgery. The cause remains unknown although it's likely to be multifactorial. In the reported case, the patient described symmetric massive engorgement of both breasts after augmentation mammoplasty. No significant change was detected in the postoperative prolactin values. The condition was unresponsive to treatment with bromocriptine. Postsurgical galactorrhea often follows a benign course culminating in spontaneous resolution Depending on symptom severity, treatment may be medical with the prescription of dopaminergic agonists, and/or surgical with drainage or even removal of the mammary implants. [ABSTRACT FROM AUTHOR]

Breast importance is evident for women quality of life. The physical and psychological trauma of mastectomy can be treated by breast reconstruction, so it's important to search for new reconstructive options decreasing complications and improving the cosmetic results. By an anatomical study in 3 fresh cadavers we observed the neurovascular anatomy of the latissimus dorsi and we founded a constant anatomy; then we realized the dorsoepigastric muscle sparing of latissimus dorsi flap taking a strip of 5 to 7cm from lateral edge of the muscle including the descending branch of the thoracodorsal artery in 9 patients meeting inclusion criteria, yielded a rate of 0.63% overall complications, decreasing donor site morbidity and improved cosmetic outcome. It was concluded that this flap is an excellent reconstructive option for breast cancer patients, although this is a pilot study and we need to expand the sample of patients to provide external validity. [ABSTRACT FROM AUTHOR]

A series of patients with unsatisfactory results after a breast augmentation surgery with silicone implants is presented in this report. The aim is to identify the most frequent problems and to offer alternatives for their solution. From an universal group of 230 patients with aesthetic breast augmentation surgery done from 2004 to 2009, a selective group of 15 patients is presented; out of these, 12 had a surgical procedure done for the first time by another medical team and 3 done by the first author of this paper. After medical evaluation 13 patients had a secondary breast augmentation surgery in order to correct the problems with satisfactory results one year postoperative. Nevertheless, 2 patients had breast stretch marks as first problem in the postoperative period which does not have a definitive solution by now. The possible reasons of the problems are: inadequate or not indicated line of access in 60%; implant size was excessive in 12 patients (80%), out of these, 10 patients requested implants with smaller size and 2 did not agree to get new implants; 2 patients (13.3%) suffered implant rupture before the first postoperative year and 1 patient had rupture after 25 years of the surgical procedure; in 12 patients (80%) there was asymptomatic capsular contracture grade I and II and grade III in 3 patients (20%). There was no information about the manufacturer of the implants in 6 patients (40%) and 10 patients (66%) did not have any information about the importance of having a certificate of guarantee on the implants. We conclude that there is a lack of unified criteria to face the secondary problems after breast augmentation surgery using silicone implants, therefore it is necessary to encourage scientific studies by universities, professional societies and governmental agencies in order to quantify sequels, classify them and offer alternatives for their solution. [ABSTRACT FROM AUTHOR]

Late seromas occur as a complication of breast implant surgery, usually after 3 months but may become evident until years later. Currently, there is scarce information about this disorder, especially with regard to the etiology. In this paper, we present our experience with this pathological entity, presenting microtrauma of the periprothesic capsule of the affected area as a possible ethiology. We describe some clinical cases, their treatment and final outcome. [ABSTRACT FROM AUTHOR]

Since 2004 we have been implementing the dual plane technique for augmentation mammoplasty in all our patients as the best one in primary augmentation mammoplasty, treatment of the capsular contracture and in the resolution of breast malformations, among which the tuberous breast was the most frequent one. This plane allows the prosthesis to stand simultaneously under and over the pectoralis major muscle. We considered 650 bilateral mammoplasties operated between january 2006 and december 2008 using smooth round implants in all cases (Mentor®). The surgery was performed with the aid of local anesthesia as well as sedation. The complication rate was minimum and it was mostly produced by hematomas and breast asymmetries. In our experience the dual plane technique admits a few variations taking into account physiological, pathological and type of breast deformity aspects, with a high rate of success and low risk. [ABSTRACT FROM AUTHOR]

We propose Dual Plane tecnique in augmentative mammoplasty as an alternative for individual adjustment when using the subfascial plane. Thirty cases are presented in which a variation of the dual plane technique is used. Its indications, advantages and surgical highpoints are discussed. This method consists on a pocket where the implant is covered by the pectoral muscle only on its upper pole, and by the fascia on the rest of it. The percentages of this components are adjusted to the anatomical characteristics of each case. Indications of this technique are primary mammoplasties, and more precisely secondary ones with ptosis, contractile capsule or ripling. [ABSTRACT FROM AUTHOR]

We present a new mastopexy technique, simpler, which precludes the recidivism and reduces the risk of breast cancer. The study was based on 25 female patients between 25 to 50 years old with breast ptosis. With the patients standing up, was realized the traditional marks. If breasts were small, implants were positioned by submuscular way, and if bigger, the way was retroglandular. For recidivism prevention, it was positioned 2 internal straps; if the gland-implant was bigger and heavier an immobile strap from the breast to the clavicle periostium and to the 3rd rib, was realized; if it would result smaller or median size only were fixed to the third ribs with a dermal flap. Controls were realized between 1 month to 3 years. Ptosis was corrected between 5 to 12cm without any recidivism, neither post surgery pseudo-ptosis. With the support of an elastic brassier, physical exercise is recommended after 15 days. The scarring was highly satisfactory. Complications were partial disruptions in 2 patients and ardors, tautness sensation and areolar enlargement in patients with more than 12cm ptosis and wide areola. Because of the execution simplicity and security, surgery was ambulatory. We propose this technique called 5th generation that precludes the periareolar, the inframamary, the vertical and the T scar; partial elimination of both upper breasts quadrants lessen the possibility of breast cancer in this upper area and ptosis recidivism by the use of the internal straps. [ABSTRACT FROM AUTHOR]

Augmentation mammoplasty has gained acceptance as a safe surgical procedure with fast recovery and a readily predictable outcome. Increasing patient expectations impose demands on natural appearance without signs of surgery. All standard incision areas for insertion of implant leave visible scars. For women with large areolar diameter, it is possible to leave a hidden scar at the aerola-nipple junction by conducting an intra- areolar approach. The technique is described and its intended application and advantages and disadvantages are discussed. [ABSTRACT FROM AUTHOR]