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Background: The current standard for breast augmentation involves placement of an implant. As an alternative, surgeons have been exploring breast augmentation with autologous tissue in the form of injectable fat., Objectives: The authors explore the efficacy and safety of lipoaugmentation of the breast, with specific interest in volume changes, fat retention, overall aesthetic improvement, and patient satisfaction., Methods: Direct measurements, 2- and 3-dimensional images, mammograms, and magnetic resonance imaging (MRI) were obtained preoperatively from 10 consecutive patients undergoing augmentation mammaplasty with autologous fat transfer. These measurements were repeated 1 year postoperatively. Postoperative photo imaging was conducted at 3-month intervals for 1 year. Efficacy was evaluated by determining the volume of fat retention 1 year after the procedure with 3-dimensional imaging, standard breast MRI volume measurements, and subjective aesthetic comparisons., Results: The average amount of fat injected was 236 cc (90-324; SD, 69.8) in the right breast and 250 cc (90-300; SD, 65.1) in the left. The mean volume change based on 3-dimensional imaging was 85.1 cc (36% retention) for the right breast and 98.1 cc (39.2% retention) for the left. The mean volume change based on MRI measurements was 30.0 cc (39.8% change) on the right and 29.3 cc (38.1% change) on the left. Blinded observers found substantial improvement in 1 patient (10%), moderate improvement in 5 patients (50%), and minimal to no improvement in 4 (40%). Overall patient satisfaction was high, as measured by the abbreviated BREAST-Q. Radiologic abnormalities and artifacts were common and required additional imaging., Conclusions: Objective breast enlargement in this study was modest but yielded disproportionately high subjective patient satisfaction reports., Level of Evidence: 2.

Background: Little data exist on the safety of elective breast surgery following breast conservation therapy., Objectives: The authors evaluate their experience performing reduction mammaplasties and mastopexies in previously irradiated breasts., Methods: A retrospective chart review was conducted of all reduction mammaplasties and mastopexies in previously irradiated breasts performed by the 2 senior authors (MYN and SLS) from 1995 to 2012 (n = 18). Patient records were analyzed for demographics, perioperative and postoperative details, and complications., Results: During the study period, 12 reduction mammaplasties and 6 mastopexies were performed on breasts previously treated with breast conservation therapy. The average study participant age was 49.5 years, and average body mass index was 29. Average preoperative bra cup size was D/DD. One patient was a former smoker; 17 were nonsmokers. Eleven of the 18 patients had been previously treated with chemotherapy; average time between radiation therapy and surgery was 2.5 years. Average specimen weight in the 12 reduction mammaplasties was 623 g. Twenty-two percent (n = 4) of patients experienced a total of 5 minor complications; none required a return to the operating room. One patient (6%) experienced a major complication resulting in approximately 50% loss of breast tissue, which was reconstructed with a latissimus dorsi musculocutaneous flap. Seventeen patients (94%) had successful outcomes with preoperative goals achieved., Conclusions: In the previously irradiated breast, reduction mammaplasty and mastopexy should be approached with extra caution, but the surgeries may still be safely and successfully performed., Level of Evidence: 4.

Background: Capsular contracture (CC) is the most common complication following primary breast augmentation and one of the most common causes of reoperation. Various studies have suggested certain risk factors, including incision choice., Objectives: The authors investigate a possible association between the three most common breast augmentation incisions (inframammary, periareolar, and transaxillary) and CC., Methods: The authors conducted a retrospective chart review of 197 primary breast augmentation patients treated between 2003 and 2009. Significant CC was determined to have occurred if the patient required reoperation for her CC. Patients were excluded if they underwent an augmentation/mastopexy, had previously undergone breast surgery, or received shaped silicone gel implants. CC rates were analyzed on a per-patient basis with Fisher's exact test and on a per-breast basis with the Rao-Scott chi-squared test., Results: One hundred eighty-three patients (336 augmented breasts) were included. Average patient age was 36.5 years. Mean follow-up was 392.6 days. Surgical complications included six breasts with CC (1.8%), three with hematoma (0.9%), and one with an infection (0.3%). Transaxillary incisions produced the highest incidence of contracture (6.4%), followed by periareolar (2.4%) and inframammary (0.5%). There was a statistically-significant difference in the incidence of CC among the three incision sites (P=.03). The increased rate seen with transaxillary incisions versus inframammary incisions was also statistically-significant. No significant association between implant fill material and contracture was found (P=.27)., Conclusions: The risk of CC is significantly higher with transaxillary incisions than with periareolar or inframammary incisions., Level of Evidence: 4.

Acellular dermal matrices (ADM) have generated interest for their possible applications in secondary revisions following prosthetic breast reconstruction. These materials can be effective in a variety of situations, including implant displacement, synmastia, capsular contracture, incisional support, and pocket conversion. ADM can also be placed in the setting of delayed breast reconstruction and to augment nipple projection. These biomaterials have demonstrated feasibility and success for many complex deformities. However, there is an associated learning curve that includes an understanding of proper technique and patient selection. The authors review their cumulative experience between 2004 and 2010 with ADM for the correction of secondary deformities following prosthetic breast reconstruction, focusing on the indications for repair, traditional management, and management with ADM.

The United States has seen significant shifts in the breast implant market over the past five decades. From the moratorium on silicone gel breast implants in 1992 to their approval in 2006, there have been many developments in their manufacturing and usage. Meanwhile, saline breast implants have remained somewhat unchanged, still offering a few distinct advantages but none of the technological innovation of the silicone gel models. In this article, the authors review the current state of silicone gel and saline implants, as well as the advantages and disadvantages of each. Much of the current data on complications of gel and saline implants are examined, as well as some practical implications associated with the use of each implant type.

Background: The number of patients receiving augmentation mammaplasty is rapidly growing. Breast cancer will develop in a significant number of these women., Objective: The authors report on a series (expanding the size of a previous study by the senior author, S.L.S.), encompassing one surgeon's experience performing breast reconstruction in women who had undergone previous augmentation. They compare the stage and detection method in this series with other published studies and also review their experience with regard to the benefit of subpectoral versus subglandular implant placement., Methods: A retrospective review of the senior author's reconstructive practice was performed, including the period from July 1983 to July 2007. Thirty-two consecutive women were identified who had previously received augmentation mammaplasty, were subsequently diagnosed with cancer, and then underwent breast reconstruction. Types of reconstructive procedures and outcomes were evaluated. A statistical analysis of the results was performed with a standard 2-tailed t test and chi(2) analysis., Results: The occurrence of breast cancer diagnosis after augmentation ranged from 1 to 25 years (mean, 15 years). No implants were ruptured at the time of mastectomy. Of the 16 patients with previous subpectoral augmentation, cancer was detected mammographically in 12 (75%). Of the 16 patients with previous subglandular augmentation, cancer was detected mammographically in 7 (44%). This difference was not statistically significant, but that may be related to the insufficient population size (P = .15). Twenty-two (69%) of the patients underwent a purely prosthetic reconstruction. Flaps were used in the other 10 (31%), including 5 (16%) latissimus dorsi flaps and 5 (16%) transverse rectus abdominis flaps. Nine (90%) of those 10 flaps were used in patients undergoing radiation therapy. There were 9 stage 0 (28.1%), 9 stage I (28.1%), 12 stage II (37.5%), and 2 stage III (6.3%) patients. Among the subglandular group, there were 5 stage 0 (31.3%), 2 stage I (12.5%), 7 stage II (43.8%), and 2 stage III (12.5%) patients. Among the subpectoral group, there were 4 stage 0 (25.0%), 7 stage I (43.8%), 5 stage II (31.3%), and no stage III or IV patients. There was no significant difference in the axillary status between the 2 implant location groups. Eleven of the total 32 (34%) patients were treated with radiation therapy. Of these patients, 2 received breast conservation therapy and the other 9 underwent mastectomy. Of the 11 augmented breasts that received radiation therapy, 9 had flaps used in their reconstruction, including 5 latissimus dorsi and 4 trans-rectus abdominis muscle flaps. The average length of follow-up for the entire group was 26.4 months (range, 1-109 months)., Conclusions: A history of breast augmentation was demonstrated to have consequences for future management of cancer in the areas of detection, cancer management, and reconstruction options. In addition, it was shown that the site of implantation may have an effect on the effectiveness of breast imaging.

Background: Large-volume lipoplasty changes body composition during a single surgical intervention by selectively decreasing subcutaneous adipose tissue. Positive health benefits, previously reported for a cohort of 14 women at 4 months after surgery, include significant decreases in weight, systolic blood pressure, and fasting insulin levels., Objective: In the present study, we sought to determine whether the benefits of altering body composition by large-volume liposuction observed at 4 months are sustained over longer periods of time., Methods: Subjects were seen for an additional follow-up visit approximately 1 year (range 10 to 21 months) after surgery. Fasting insulin levels were measured in the 8 patients who had preoperative fasting insulin levels higher than 12 muU/mL. Weight, systolic and diastolic blood pressure, heart rate, and body circumferences were measured in all 14 subjects., Results: Compared with data obtained before surgery and 4 months after surgery, results at 10 to 21 months after lipoplasty showed that the improvements in body weight, systolic blood pressure, and fasting insulin levels observed 4 months after the procedure had been maintained., Conclusions: Should these results be confirmed in larger studies, lipoplasty may prove to be a valuable tool for reducing some of the co-morbid conditions associated with obesity. (Aesthetic Surg J 2001;21:527-531.).

Learning Objectives: The reader is presumed to have a broad understanding of plastic surgical procedures and concepts. After studying this article, the participant should be able to: Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination based on material covered in this article. The examination begins on page 175. A retrospective study was performed to compare reoperative breast implantation surgery before and after the Food and Drug Administration (FDA) hearings in 1991 and 1992 on silicone breast implants. The two groups were compared regarding the motivation, findings, and procedures associated with the operations. One hundred seventy-one patient records were reviewed covering the years 1989 to 1994, evenly straddling 1991; of those, 146 charts had sufficient data to be included in the study. Each implant and each implantation operation were counted as a separate event. Before November 1991, 64% of reoperations were performed on the senior author's own original patients, whereas after 1991, only 33% were. Fifty-seven percent of the reoperations performed before November 1991 were performed on patients requiring augmentation in contrast to those patients requiring reconstruction; after 1991, 78% of the reoperations were augmentation mammaplasties. In the early period, reoperation was primarily performed to correct asymmetry (47%) or capsular contracture (47%); it was rarely performed for rupture (3%) or infection (3%) and never for anxiety or pain. In the later period, contracture (44%) and asymmetry (18%) remained as common causes, but anxiety (11%) and pain (8%) appeared as new factors, and rupture was suspected more often (21%). One of the most dramatic, if not surprising, findings was the choice for replacement implant. In the earlier period, saline solution-filled implants were used 12% of the time, whereas in the later period, they were used 80% of the time. Finally, implants removed that were more than 15 years old had ruptured nearly 50% of the time.