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Breast augmentation ranks among the most popular plastic surgery procedures. Yet, reports on post-operative patient-reported quality of life (QoL) and satisfaction remain conflicting. A systematic review was conducted following the PRISMA guidelines. Three databases were searched for eligible studies that reported pre-and/or post-operative Breast-Q™ augmentation scores for patient QoL (psychosocial, sexual, and physical well-being) and/or satisfaction. A total of 39 studies (53 patient cohorts and 18,322 patients) were included in the quantitative synthesis. The pairwise meta-analysis revealed significant improvements in patient-reported psychosocial (MD: +38.10) and sexual well-being (MD: +40.20) as well as satisfaction with breast (MD: +47.88) (all p < 0.00001). Physical well-being improved slightly after breast augmentation (MD: +6.97; p = 0.42). The single-arm meta-analysis yielded comparable results, with Breast-Q™ scores in psychosocial and sexual well-being as well as satisfaction with breast increasing from 37.2, 31.1, and 26.3 to 75.0, 70.6, and 72.7, respectively (all p < 0.00001). Physical well-being improved by 8.1 (75.8 pre-operatively to 83.9 post-operatively; p = 0.17). Subgroup analyses highlighted higher QoL and satisfaction following breast augmentation for purely esthetic purposes and alloplastic mammaplasty. Although patient-reported physical and sexual well-being increased in the long term, psychosocial well-being was the highest in the short term. Patient satisfaction with breast, psychosocial, and sexual well-being increased significantly after breast augmentation. In contrast, patient-reported physical well-being yielded ambivalent results, varying by mammaplasty technique and post-operative follow-up time. Plastic surgeons should be sensitized about our findings to refine eligibility criteria and gain a deeper understanding of the patients' perceived surgical experience. CRD42023409605. [ABSTRACT FROM AUTHOR]

Background and Objectives: Mammary gland surgery has become very common, but there are complications of these operations, including the concept of breast implant illness (BII) in women with silicone gel breast implants (SBI), who suffer from various symptoms such as myalgia, arthralgia, fatigue, fever, dry eyes, or dry mouth. Silicone biomaterials are synthetic polymers that have their own physical and chemical properties and can exert their effect at the site of use and possibly on the general status of the body, causing inflammation and oxidative stress signs. The aim of the study was to examine components of the blood antioxidant system (AOS) of the mastopexy and breast augmentation patients before the operation, on the first post-op day, and 6 months after surgery. Materials and Methods: Healthy breast surgery patients (women aged 31 to 60 years without visible pathologies) were selected for the study and formed 2 groups: breast lift—mastopexy without silicone biomaterials (I group, 30 patients) and breast augmentation using silicone biomaterials (II group, 28 patients). All patients underwent standard preoperative tests. Glutathione peroxidase (GPxSe) and gamma-glutamyl transferase (GGT) in blood, selenium (Se), selenium protein P (SelPP), and total antioxidant status (TAS) in plasma were measured as AOS parameters. The concentration of vitamin D was also determined. A total of 174 blood tests were performed. Results: Overall, there were no differences in both groups in measured antioxidant system indicators over time; neither changes in objective nor subjective status were observed. However, baseline activity of GPxSe was relatively high but restored to normal values 6 months after surgery. In the mastopexy group, GPxSe decreased from 12,961.7 U/L by 18.9% to 10,513.4 U/L, and in the breast augmentation group, from 15,505.0 U/L by 25.1% to 11,265.5 U/L, which is a decrease of 18.9% and 25.1%, respectively. The patients did not note any complaints; other indicators of standard biochemical tests were within normal limits. Conclusions: The two types of surgical interventions, breast mastopexy and augmentation of the mammary glands, do not significantly impact blood AOS and are physiological in nature. [ABSTRACT FROM AUTHOR]

Background and Objectives: The correction of breast hypertrophy and ptosis with implant placement has always posed a challenge for plastic surgeons. Various methods have been devised, yielding conflicting results. The purpose of this study is to describe our surgical technique of breast reduction with silicone implants, present the safety profile of the procedure, and report patient-reported outcomes. Materials and Methods: A retrospective review was performed on our case series of cosmetic breast surgery performed by the senior author between October 2020 and November 2023. Only patients who had over 300 g of breast tissue removed were included. The surgery and demographic characteristics were recorded. Patients were asked to complete a questionnaire about satisfaction with their breasts pre-operatively and after the surgery. Results: Over 745 cases were performed, and 25 were included in the analysis. In total, 78.3% of the patients presented with a Grade 3 ptosis. The mean implant size was 352.39 cc (range 300–455 cc). The breast tissue removed ranged from 312 to 657 g. The mean follow-up was 14.17 months. Only one case required revision surgery after developing capsular contracture and a waterfall deformity. Patients reported a statistically significant improvement across all domains of the questionnaire (p < 0.001). Conclusions: Breast reduction plus implants is a safe and effective alternative for patients with large ptotic breasts who wish to attain a full upper pole. It carries a similar risk profile to augmentation mastopexy and maintains its functional benefits in alleviating back, neck, and shoulder pain. [ABSTRACT FROM AUTHOR]

Background: The task of promoting patient safety and aesthetically pleasing results, without exceeding anatomical limitations or compromising surgical outcomes, is one of the biggest challenges plastic surgeons face today. Methods: This is a multicenter, single-surgeon retrospective study evaluating the long-term safety and aesthetic results of Motiva Ergonomix® implants in 325 consecutive female recipients undergoing bilateral primary breast augmentation procedures, predominantly performed with a minimal incision approach between 2 and 3.5 cm. As a secondary benefit of the study, we aim to provide insight into modern patient needs and desires expressed during the pre-operative implant selection process, and data collected evaluating patient satisfaction rates using a pre-operative and post-operative Breast-Q questionnaire and a Patient and Observer Scar Assessment Scale (POSAS). Results: Between 2015 and 2019, six hundred and fifty Ergonomix® implants were implanted into 325 consecutive patients undergoing primary breast augmentation with a mean minimal incision length of 2.9 cm (range 2–3.5 cm). The mean follow-up time was 14 months with a range of 6 to 48 months. Over the 5 years, a total of 7 complications were reported among 325 patients with an overall complication rate of 2.15% and an overall reoperation rate of 1.23% (N = 2). Conclusions: Ergonomix® implants can provide a favorable choice for balancing both safety and aesthetics in primary breast augmentation procedures. Level of evidence: III, Risk/Prognostic Study [ABSTRACT FROM AUTHOR]

Background: Ptosis and volume atrophy of the breasts are common symptoms for various ages of women and may induce a considerable amount of stress in daily life. Periareolar augmentation mastopexy is an effective procedure for such conditions, and planning the new nipple position is very important. Aim: To provide a simple, straightforward planning and walkthrough of this operation in a journey to find the ideal level of breast lifting for natural upper fullness. Materials and methods: From January 2019 to December 2021, a total of 193 patients with volume deflation and ptosis of the breast received periareolar augmentation mastopexy in our institute. We retrospectively reviewed data on demographics, surgical procedures, outcomes, and complications. Results: All operations were done with periareolar incisions, and the mean follow-up period was 29.48±9.11 months. The Likert scale of outcome satisfaction scored 9.02±0.61. Complications were minimal, and no symmastia or bottoming out occurred. Conclusion: We present our basic strategies of periareolar augmentation mastopexy with a slight modification of the design. We believe that lifting the nipple to 3–4cm above the inframammary fold (IMF) (making the top of the areola about 5–6 cm above the IMF) yields satisfactory aesthetic results. [ABSTRACT FROM AUTHOR]

Background Breast augmentation in transwomen is a surgical challenge as there is no available guideline for preoperative assessment of breast implant size, which caters to them specifically. The aim of our study is to derive a formula for preoperative breast implant size estimation, which would remove the personal bias, help in one-to-one discussion, and better understanding, reducing operative time, cost, and revision surgery rate. Methods This is a retrospective study conducted from October 2018 to December 2020. We maintained a routine protocol for measurements in our patients, which has been previously published. Linear multivariate regression equation was applied to derive a formula using minimum of parameters, namely, CC (chest circumference at the inframammary fold [IMF]), POMP (circumference at the point of maximum projection of breast mound), and LOWERDIFF (lower value of difference in each breast between the stretched nipple [IMF] and the nonstretched nipple [IMF distance]). Results A total of 51 transwomen underwent surgery in this period. The mean volume of implant used was 354.51 mL. Complications consisted of pain and discomfort in six patients, delayed healing in two patients, and wound dehiscence in one. A formula for preoperative calculation of breast implant was obtained with these data. A mathematical correlation was found between complications encountered and the percentage by which the inserted implants exceeded the calculated size. Conclusion We could estimate the breast implant size preoperatively through a simple formula that require only four anthropometric measurements. This equation is a significant advantage for the surgeon and a useful tool for patient education. Its usefulness will be established if applied in prospective studies. From our study, it appears 9% above the calculated size is better avoided. [ABSTRACT FROM AUTHOR]

Background: Implant rupture is one of the complications of breast augmentation surgery. The rupture of silicone implants is often insidious, potentially causing problems at any time. This is a case report of the rupture of 145-cc breast implants manufactured by Dow Corning Corporation and their removal at 40 years after augmentation. Case Presentation: A 70-year-old female patient was admitted for the removal of a lump in the upper and inner quadrants of the right breast. After a detailed examination, a rupture of the bilateral breast implants was diagnosed. Explantation without replacement was performed; the entire procedure proceeded smoothly. Immunohistochemical staining revealed siliconoma with lymphoid hyperplasia and calcification in the bilateral breasts with no signs of malignancy. Conclusions: Silicone breast augmentation is one of the most popular aesthetic surgical procedures worldwide. Therefore, it is important to educate patients on the need for close monitoring of their implants after augmentation through magnetic resonance imaging or ultrasound to facilitate early detection of any changes before a rupture occurs. Early detection of the implant rupture, in turn, will facilitate early and effective management. [ABSTRACT FROM AUTHOR]

Background: Due to risks of texturization, the use of textured breast implants has been diminishing worldwide and is expected to continue to decline. The crisis with textured devices raises the need to revisit the use of smooth round silicone gel (SRSG) implants and to discuss the results that can be achieved with this alternative. The article aims to exclusively analyze SRSG devices: the changes associated with implant profile and degrees of filling, how these changes correlate to certain aesthetic outcomes, and the predictability and stability of these results over time. Methods: The experimental component of this study investigated the effect of gravity on various profiles of SRSG implants when their position was changed. The study's clinical component was a retrospective analysis of primary retropectoral breast augmentation patients with a minimum 1-year follow-up after the procedure. Results: In the experimental setting upon changing position, the anatomic conformation in higher profile devices was more visible compared with their lower profile counterparts. Clinical results of 92 augmented breasts (46 patients) with various types of SRSG implants revealed a full scope of aesthetic outcomes. Desired results were achieved even in challenging scenarios. Breast shape and upper pole contour were predictable with reliable and stable control over time. The overall complication rate was comparable to other breast implant studies. Conclusions: With proper device selection and good surgical technique, any aesthetic outcome can be achieved in retropectoral placement while keeping also prioritizing patient safety. Moderate and moderate plus profile underfilled implants are recommended when anatomical results are intended. Level of evidence: Level IV, Therapeutic. [ABSTRACT FROM AUTHOR]

For decades, implant-based breast augmentation has been one of the most performed surgical procedures for cosmetic purposes around the world. Hence, novel manufactured implants should be critically investigated to prove them safe and effective. Here, the authors describe the first independently conducted clinical study on Nagor Impleo textured round breast implants. For this retrospective study, outcomes of 340 consecutive female patients undergoing primary cosmetic breast augmentation were analyzed. Demographic and surgical data as well as outcomes and complications were evaluated. Furthermore, a survey concerning effectiveness and aesthetic satisfaction after breast augmentation was examined. All 680 implants were placed in a submuscular plane with incisions at the inframammary fold. The main indications for surgery were hypoplasia and hypoplasia with asymmetry. The mean implant volume was 390 cc and the main type of projection was high profile. The most common complications were hematoma and capsular contracture (0.9 percent, respectively). The overall revision rate for complications was 2.4%. Additionally, almost all patients showed increased quality of life and aesthetic satisfaction after a breast augmentation. Hence, all patients would undergo breast augmentation again with these newly launched devices. Nagor Impleo implants demonstrate a low complication rate and high safety profile. Although high aesthetic satisfaction and quality of life results were achieved, analysis of an even larger series over a longer period of time would be beneficial to evaluate the reliability of this implant. [ABSTRACT FROM AUTHOR]

Background: Single-stage augmentation mastopexy is popular approach in managing patients with ptosis and volume loss. Despite its growing popularity, there is still on-going debate about performing this procedure as a one-stage operation as opposed to two-stage procedure due to possible increase of significant complications when the single stage approach is used. Our study aims to analyse the safety of the approach by assessing the complication rate and subsequently investigate how these unfavourable outcomes were managed. Methods: Retrospective analysis included 85 patients who underwent single stage augmentation mastopexy by a single consultant surgeon. Complications were divided into major (admission < 30 days, non-cosmetic surgery under general anaesthesia (GA) > 30 days) and minor (not requiring admission < 30 days) and those with an unfavourable cosmetic outcome. Results: Sixty two percent (N = 53) underwent the single stage mastopexy and augmentation without experiencing any complications. 8% (N = 7) of the patients experienced major complication, requiring operation under GA; 18% (N = 15) experienced minor complications, all managed non-operatively. 14% (N = 12) patients were classified as having an unfavourable cosmetic result. 15% (N = 13) patients required a second operation under GA, and 6% (N = 7) required revision under local anaesthesia. Mean follow-up was 34 months. Higher complication rate was noted to be in higher ASA group (P = 0.04) and demonstrated tendency in higher rate with the use of greater volume implants (P = 0.06). Conclusions: Single-stage augmentation mastopexy remains a safe approach in selected patients, with the additional benefits of convenience and cost. Complication rates are comparable to the overall complication rates in 2-stage approach technique. Level of evidence: Level IV, Risk / Prognostic study. [ABSTRACT FROM AUTHOR]

This study of breast augmentations performed under local anesthesia with intercostal blocks and light sedation describes the outcomes and evaluates benefits and complications. From December 2005 until August 2019, 335 women consecutively underwent bilateral breast augmentation procedures. The anesthetic protocol consisted of an initial intravenous bolus of 1 mg midazolam and 0.25 mg alfentanil preoperatively. In 2017, this was changed to 2–4 mg midazolam intramuscularly, 1 mg midazolam intravenously, and 2.5 µg sufentanil intravenously. Intercostal blocks were injected at the midaxillary line into the intercostal spaces two to seven. The operating field was infiltrated with tumescent local anesthesia. Retrospective data extraction from patients' medical charts was done, registering demographics, dosage of anesthesia, surgical characteristics, complications, and reoperation rates. Two hundred and eighty-one women underwent primary augmentation and 54 had implant replacement. The most common complications included suboptimal cosmetic results, asymmetry, and healing-related problems. The overall rate of reoperation was 16.1% within an average follow-up period of 2 years, ranging from 0 to 12.5 years. The majority of the reoperations were due to cosmetic reasons. The change in anesthetic regime was associated with a significantly (p < 0.0001) decreased need for supplementary medication with no increased risk of complications. Breast augmentations in local anesthesia with intercostal blocks and light sedation can be performed safely and can serve as an alternative to procedures in general anesthesia. [ABSTRACT FROM AUTHOR]

Due to the inability to block the medial and lateral thoracic nerves, it is often used in conjunction with thoracic nerve block to better alleviate postoperative pain in breast augmentation surgery. Keywords: Serratus anterior plane block; Breast surgeries; Breast augmentation EN Serratus anterior plane block Breast surgeries Breast augmentation 1105 1107 3 06/27/23 20230801 NES 230801 Binggao Chai and Jianlong Du contributed equally to this work as co-first authors. Familiarity with breast innervation, the scope of surgical invasion, and the anatomical basis of local nerve block techniques can help choose an appropriate nerve block technique to better alleviate pain during breast augmentation surgery. [Extracted from the article]

Background: The inframammary approach is one of the most commonly used incisions in breast augmentation. There are many suture methods for inframammary incisions; however, no one method has proven optimal. We modified the traditional three‐layer suture method according to the inframammary fold (IMF) cadaver dissection results. This study aims to investigate whether using a modified suture method can improve postoperative outcomes. Methods: Cadaver dissections were performed in order to clarify the anatomy of the IMF. From June 2013 to December 2017, a retrospective study of primary breast augmentation patients subjected to the inframammary approach was conducted. Patients were divided into two cohorts: the traditional suture method and the modified suture method. The patient's demographics, specifics of breast augmentation procedures, complications, and scar assessment were analyzed. Univariate and multivariable analyses were used to determine differences between the two cohorts. Results: One hundred eighty‐four patients were included: 75 patients were subjected to the traditional suture method, and 109 patients were subjected to the modified suture method. Wound‐related adverse events (p = 0.026) and IMF‐indented scarring (p = 0.014) were significantly different between the two groups. Multivariable analysis showed that the suture method was the most influential factor related to IMF‐indented scarring (OR = 16.9), followed by BMI (OR = 2.9). Conclusions: We defined a new suture method for the inframammary incision in primary breast augmentation. This modified suture method reduces the occurrence of wound‐related adverse events and IMF‐indented scarring. [ABSTRACT FROM AUTHOR]

Background: Breast augmentation is one of the most demanded procedures in plastic surgery and one of the most commonly performed by plastic surgeons. However, a bibliometric analysis of breast augmentation has not been published in recent years. The current study aimed to use a bibliometric analysis to conduct a qualitative and quantitative evaluation of breast augmentation research and provide the research trends and hotspots in this field. Methods: Publications on breast augmentation research were extracted from the Web of Science core collection database. VOSviewer 1.6.18 was used to assess co-authorship, co-occurrence, citation of countries, institutions, authors, and journals, as well as hotspot keywords. Results: On February 8, 2022, 4637 records of breast augmentation research published from 1985 to 2021 were collected. The bulk of the retrieved studies were original research articles (n = 2235, 48.20%). A total of 1053 (22.71%) papers were open access. The annual publication output increased annually. The USA was the driving force in this field and had a strong academic reputation. The top-contributing institution was the University of Texas MD Anderson Cancer Center (2.37%, with 110 publications). Plastic and reconstructive surgery (998 publications, 21.52%) published the most research in this field and was also the most frequently co-cited journal (22,351 citations, total link strength (TLS): 409,301). Clemens MW (68 publications, 1.47%) was the most prolific author, and Spear SL (1456 citations, TLS: 27,231) was the most frequently co-cited author. The research hotspots included the following four aspects: safety and effectiveness of breast implants, implant-based breast reconstruction, breast cancer incidence after breast implantation, and breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). The research trends were BIA-ALCL, implant-based breast reconstruction, BREAST-Q, acellular dermal matrix, capsular contracture, and autologous fat grafting. Conclusion: The present study provides a panoramic view of breast augmentation research in plastic and reconstructive surgery. This novel comprehensive bibliometric analysis can help researchers and nonresearchers alike to rapidly identify the potential partners, research hotspots, and research trends within their areas of interest. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Breast augmentation is one of the most frequently performed cosmetic surgeries in the world. However, there is no standardized surgical procedure for performing breast augmentation. Many modalities exist for this surgery which may explain why practices vary greatly from one surgeon to another. The aim of this study was to evaluate current practices of breast augmentation by implant in France and changes in practices among French plastic surgeons. This observational study was conducted between February 2020 and January 2021. An online questionnaire with 62 questions was sent to 729 French plastic surgeons. The questions concerned: the population of surgeons interviewed, pre-operative aspects, surgical technique and post-operative management. 411 plastic surgeons responded, 5.1% of surgeons impose a nicotine screening test on patients. 99.76% and 95.59% reported that they used silicone gel implants and round prostheses. All used smooth or micro-textured shells. The inframammary approach was the most used by 66.2% of plastic surgeons. The implants placed were between 250 and 300 cc on average and were mainly placed in "Dual plane" by 42% of surgeons. In order to reduce bacterial contamination, 26% of surgeons soaked the implants in a povidone-iodine solution and 23% used an insertion sleeve. The most frequent early complication was hematoma, while capsular contracture was a late complication. This study provides new data on current surgical practices of breast augmentation in France, allowing more informed choices and opening up perspectives for more standardized practices in the future. [ABSTRACT FROM AUTHOR]

Three-dimensional Surface Imaging (3DSI) has become a valuable tool for planning and documenting surgical procedures. Although surface scanners have allowed for a better understanding of breast shape, size, and asymmetry during patient consultation, its use has not been included in intraoperative assessment so far. Validation of the reliability of the intraoperative use of a portable handheld 3DSI equipment as a tool to evaluate morphological changes during breast augmentation surgery. The patients who underwent bilateral subpectoral breast augmentation through an inframammary incision were included in this study. Intraoperative 3DSI was performed with the Artec Eva device, allowing for visualization of the surgical area before incision, after use of breast sizers and implant, and after wound closure. Intraoperatively manual measurements of breast distances and volume changes due to known sizer and implant volumes were in comparison with digital measurements calculated from 3DSI of the surgical area. Bilateral breasts of 40 patients were 3D photographed before incision and after suture successfully. A further 108 implant sizer uses were digitally documented. There was no significant difference between manual tape measurement and digital breast distance measurement. Pre- to postoperative 3D volume change showed no significant difference to the known sizer and implant volume. [ABSTRACT FROM AUTHOR]

Objective To compare and study the breast morphological changes after dual-plane augmentation through different approaches. Methods Fifty patients underwent primary breast augmentation from February 2018 to December 2019 were divided into 3 groups. There were 20 patients in the trans-axillary approach group, 10 patients in the inframammary fold (IMF) approach group and 20 patients in the periareolar approach group. All patients were asked to take 3D images by Vectra 3D system before and 6 months after surgery. The 3D images were analyzed by Geomagic Studio 19.0 software. Results There was no statistically significant difference of the straight-line distance from suprasternal notch to nipple (SN-N) and the distance from nipple to the midline of sternum (N-M) before and after surgery among 3 groups (P>0.05). There was statistically significant difference between preoperative and postoperative SN-N and N-M in the trans-axillary approach group (P<0.05). There was no statistically significant difference in the IMF approach group and periareola approach group (P>0.05). In the IMF approach group, the distance of suprasternal notch at the level of the lowest point of the inframammary fold (SN-LIMF) was changed after surgery (P<0.05). There was no statistically significant difference in the trans-axillary approach group and periareolar approach group (P>0.05). The total breast volume in 3 groups increased after surgery. The total breast volume in each group after surgery was smaller than the expected volume (P<0.05). The volume percentage decreased above the level of nipple, while increased below the level of nipple after surgery. The difference in preoperative and postoperative volume and percentage among 3 groups was not statistically significant (P>0.05). Conclusion The dual-plane augmentation through 3 approaches can achieve good and nature appearance of breast. The difference of breast morphological changes among 3 groups is low. [ABSTRACT FROM AUTHOR]

Objective: To examine the putative associations between breast implants and postpartum lactational mastitis. Design: Observational retrospective study. Setting: Digital database of Maccabi Healthcare Services, integrated health maintenance organisation in Israel. Population: Breastfeeding mothers from 2003 to 2016 based on an initial health maintenance organisation data set of 28 383 singleton live births in Israel. Methods: Multivariate analysis and propensity score matching were used to test the extent to which breast implants were associated with lactational mastitis during the 6‐month postpartum period in breastfeeding mothers. Analyses for potential confounders were adjusted for socio‐economic status, smoking and parity. Main outcome measure: Lactational mastitis among breastfeeding women with breast implants compared with women without breast implants. Results: Mothers with breast implants (n = 6099) were significantly (P < 0.001) more likely to be diagnosed with postpartum mastitis (8.3%) than mothers with no breast implants(n = 22 284) (6.6%) at an odds ratio of 1.22 (95% CI 1.09–1.35) after adjusting for confounders. Conclusion: Breast augmentation is associated with an increased risk of postpartum lactational mastitis in the 6‐month postpartum period. In light of these findings, it is important for health professionals to instruct women who have undergone breast augmentation on correct breastfeeding techniques, ways to avoid risk factors, and to be alert to signs permitting the early detection of lactational mastitis. A study of over 28,000 breastfeeding women has shown that breast augmentation is associated with an increased risk of postpartum lactational mastitis in the six‐month postpartum period. A study of over 28,000 breastfeeding women has shown that breast augmentation is associated with an increased risk of postpartum lactational mastitis in the six‐month postpartum period. [ABSTRACT FROM AUTHOR]

Objective: Breast augmentations are among the most common interventional cosmetic procedures performed nowadays, but scarcity of data exists on its effects on breastfeeding. Our aim was to evaluate whether breast augmentation adversely affects breastfeeding.Study Design: A retrospective cohort study using database of a 2.3-million-member state mandate health maintenance organization (HMO). We identified primigravida women with a singleton pregnancy who delivered between the years 1998-2016, at gestational age of >34 weeks of gestation. Study group included women with breast augmentation surgery, which compared to control group of women who did not undergo breast augmentation. The primary outcome was documentation of any breastfeeding during the first three months postpartum.Results: Overall, 14,919 women were included, of them, 3913 and 11,006 women with and without breast augmentation, respectively. Women with breasts augmentation were younger (29.8 ± 3.6 years vs. 30.9 ± 4.0 years, p < 0.001), had lower pre-pregnancy BMI (25.2 ± 5.0 vs. 26.36 ± 5.0 Kg/m2, p < 0.001), belong to higher socioeconomic status level and less religious communities. Breastfeeding rates in the study group were lower as compared to controls (70.7% VS 85.1%; p < 0.0001), with an adjusted odds ratio of 0.42(95% CI: 0.38-0.461). Maternal diabetes mellitus and advanced maternal age were associated with a lower likelihood of breastfeeding (95% CI:0.45-0.78, p-value < 0.0001), while belonging to religious communities were associated with higher breastfeeding rates (95% CI: 1.34-1.99, p-value < 0.0001).Conclusion: Women with breast augmentation tend to breastfeed less than women without breast augmentation, during the first three month of postpartum. [ABSTRACT FROM AUTHOR]

A subgroup comparison between 1,797 women whose date of implant placement was known (and who were free of autoimmune disease at that time) and 7,109 women without implants showed a statistically significant hazard ratio of 1.45 (95% CI 1.21-1.73) for "any autoimmune disease" associated with silicone breast implants. Neither was a difference found in the prevalence of breast implant illness manifestations in a report by Miseré et al., who compared unselected women with silicone breast implants with healthy controls without silicone breast implants selected from friends and family [[9]]. Keywords: Breast implant illness; silicone breast implants; autoimmune disease; breast reconstruction; breast augmentation EN Breast implant illness silicone breast implants autoimmune disease breast reconstruction breast augmentation 773 775 3 07/25/22 20220801 NES 220801 Dear Editor With great interest, we read a recent literature review on Breast Implant Illness by Cohen Tervaert et al. in Expert Review of Clinical Immunology [[1]]. Breast implant illness, silicone breast implants, autoimmune disease, breast reconstruction, breast augmentation. [Extracted from the article]

Background: The aesthetic long-term stability in shape, symmetry, and natural appearance of an aesthetically augmented breast remains a constant challenge. It has become clear that the results depend strongly on the technique applied and the experience of the surgeon. An ongoing controversy concerns the positioning of the implants. Subglandular, submuscular, partial submuscular, and subfascial pockets have different tradeoffs and advantages. However, secondary deformity, unnatural feel, and appearance are not addressed uniformly. The aim of the following study was to establish a standard procedure allowing for the desired and reproducible results to provide long-term stability and aesthetic quality. Methods: The authors have developed a standardized dissection of a dynamic implant pocket. In this approach, a submuscular dissection with lower and medial release of the pectoralis muscle is combined with a wide subfascial release of the breast gland and a scoring of the deep plane of the superficial glandular fascia. In the final step, the deep layer of the glandular fascia is sutured tightly and firmly to the deep layer of the abdomino-pectoral fascia. A total of 867 patients received a 4D pocket–based breast implant by the authors. A subset of 33 patients was further analyzed for long-term results. Retrospectively, all data were analyzed from the electronic patient information system and files of patients using GraphPad 8. For comparison of multiple experimental groups, one-way ANOVA was performed where indicated. Results: The concept not only addresses the biplanar approach of submuscular implant placement (3D) but adds the 4th dimension (4D) of an aesthetically pleasing dynamic shape of the augmented breast providing long-term stability. Measurements—taken at 3 months, and 1, 2, 3, 5, and ≥ 7 years post augmentation—for SN-N, N-IMF, N-ML, and MC-N distances did not show any significant changes over time. In the patient cohort of 867 patients (1734 implants), the overall complication rate was < 5%. Revisions for bleeding were below 0.5%. Shape stability was observed over 7 years in more than 95% of the patients. Conclusions: Our results indicate that our technique of multiplane breast augmentation provides long-term stability and aesthetic quality. It may solve some of the existing tradeoffs of the different methods by combining the benefits of each technique supported by an additional shaping through a controlled deep fasciotomy. Level of evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Purpose: To assess precise topographic changes of the breast, objective documentation and evaluation of pre- and postoperative results are crucial. New technologies for mapping the body using digital, three-dimensional surface measurements have offered novel ways to numerically assess the female breast. Due to the lack of clear demarcation points of the breast contour, the selection of landmarks on the breast is highly dependent on the examiner, and, therefore, is prone to error when conducting before-after comparisons of the same breast. This study describes an alternative to volumetric measurements, focusing on topographic changes of the female breast, based on three-dimensional scans. Method: The study was designed as an interventional prospective study of 10 female volunteers who had planned on having aesthetic breast augmentation with anatomical, textured implants. Three dimensional scans of the breasts were performed intraoperatively, first without and then with breast implants. The topographic change was determined as the mean distance between two three-dimensional layers before and after augmentation. This mean distance is defined as the Topographic Shift. Results: The mean implant volume was 283 cc (SD = 68.6 cc, range = 210–395 cc). The mean Topographic Shift was 7.4 mm (SD = 1.9 mm, range = 4.8–10.7 mm). The mean Topographic Shifts per quadrant were: I: 8.0 mm (SD = 3.3 mm); II: 9.2 mm (SD = 3.1 mm); III: 6.9 mm (SD = 3.5 mm); IV: 1.9 mm (SD = 4.3 mm). Conclusion: The Topographic Shift, describing the mean distance between two three-dimensional layers (for example before and after a volume changing therapy), is a new approach that can be used for assessing topographic changes of a body area. It was found that anatomical, textured breast implants cause a topographic change, particularly on the upper breast, in quadrant II, the décolleté. [ABSTRACT FROM AUTHOR]

Breast augmentation belongs to one of the most desired aesthetic surgeries worldwide. Even though silicone implants are used in the majority of breast enlargements, there are still patients treated with injectable fillers. Despite of a less invasive procedure, injectable materials often lead to serious complications. We present a case of a late inflammatory complication 20 years after an injection of unknown filler material. Regardless of early antibiotics treatment, the initial unilateral mastitis spread to the contralateral breast and both supraclavicular and axillar regions leading to a surgical revision and evacuation of the entirely consumed mammary glands. It is a surprising observation of a fast-expanding mastitis two decades after filler application. Breast augmentation belongs to one of the most desired aesthetic surgeries worldwide. Even though silicone implants are used in the majority of breast enlargements, there are still patients treated with injectable fillers. Despite of a less invasive procedure, injectable materials often lead to serious complications. We present a case of a late inflammatory complication 20 years after an injection of unknown filler material. Regardless of early antibiotics treatment, the initial unilateral mastitis spread to the contralateral breast and both supraclavicular and axillar regions leading to a surgical revision and evacuation of the entirely consumed mammary glands. It is a surprising observation of a fast-expanding mastitis two decades after filler application. [ABSTRACT FROM AUTHOR]

The internet is a knowledge technology and market place, ingrained in everyday social life, which provides an avenue to examine social and gendered relationships. This paper examines a particular gendered arrangement, how breast augmentation is offered to women on internet websites. Breast augmentation is rapidly becoming the most popular cosmetic surgery for Western women. We identified and analysed the content of 20 New Zealand websites offering breast augmentation surgery. Analysis documented two major issues that dominated website presentations. The first positioned breast augmentation as a solution to a deficient breast. Reworking the breast allows possibilities for women to construct revised subjectivities, within socially constrained and gendered norms, dominated by idealized female forms. The second positioned breast augmentation as an elective choice of neoliberal consumerism, constrained by gendered expertise, and a lack of information about the risks and complications of this surgery. We reveal how cosmetic surgery websites selling breast augmentation are complex medicalized sites, raising important issues for further research. [ABSTRACT FROM AUTHOR]

Breast augmentation with various injectable materials has been performed for decades. Aquafilling was developed in 2005 as soft tissue filler for facial contouring and recently its use for breast augmentation has gained speed in several countries. Its declared composition is 98% water and 2% copolyamide. Although not approved by the U.S. Food and Drug Administration, the procedure is increasingly applied in Turkey. Thus, familiarity with specific imaging findings and complications of this entity is important for the correct diagnosis. Possible migrated material should especially be sought for when reporting these cases. Hereby, we present two cases with a history of breast augmentation with Aquafilling, with special emphasis on MRI findings. Two female patients (ages 28 and 32) were referred for breast ultrasonography (US) with progressive swelling of the right breast (4 years after Aquafilling) and mastalgia (1 year after Aquafilling). Breast MRI at 1.5T (Siemens Espree) with 4-channel breast coil was performed. High-resolution non-fat sat T1- and T2-weighted (W) images, time of repetition-independent multislice (TRIM), and diffusion-weighted imaging (DWI), and for the silicone assessment, water-suppressed and fat-suppressed (WS-FS) sequences, were used. No contrast was administrated. Knowledge of the radiologic characteristics and migration patterns of Aquafilling material as well as related complications is very useful to make an accurate diagnosis. Level of Evidence: Level V, diagnostic study. [ABSTRACT FROM AUTHOR]

Purpose: Breast augmentation is the most commonly performed aesthetic operation in the Unites States annually. With the increasing popularity of gel implants, optimal incisional length for specific implant volumes becomes a factor to consider. Our study is the first, to date, to measure optimal incisional length for increasing Mentor smooth, round, moderate plus silicone implant volumes. Method: Three cadaver breasts were dissected in our anatomy laboratory. After dissection of a subpectoral pocket via an inframammary fold incision, time of implant insertion was measured for increasing volumes with the use of increasing incisional site lengths. Results: Values for increased incisions are as follows: 2.5-cm incision facilitated 100-cm3 implant (average time [AvgT] 76 seconds); 3-cm incision 100-cm3 implant (AvgT 32 seconds), 200 cm3 (AvgT 84.33 seconds); 3.5-cm incision 100-cm3 implant (AvgT 13.00 seconds), 200 cm3 (AvgT 22.00 seconds), 300 cm3 (AvgT 33.67 seconds); 4-cm incision 100-cm3 implant (AvgT 5.67 seconds), 200 cm3 (AvgT 11.33 seconds), 300 cm3 (AvgT 21.33 seconds), 400 cm3 (AvgT 26 seconds); 4.5-cm incision 100-cm3 implant (AvgT 5 seconds), 200 cm3 (AvgT 15.17 seconds), 300 cm3 (AvgT 19.67 seconds), 400 cm3 (AvgT 26 seconds), 500 cm3 (AvgT 39.67 seconds), 600 cm3 (AvgT 59.33 seconds), 700 cm3 (AvgT 78.67 seconds); 5-cm incision 100-cm3 implant (AvgT 1 second), 200 cm3 (AvgT 3.67 seconds), 300 cm3 (AvgT 8 seconds), 400 cm3 (AvgT 13 seconds), 500 cm3 (AvgT 19.33 seconds), 600 cm3 (AvgT 23.33 seconds), 700 cm3 (AvgT 28 seconds), 800 cm3 (AvgT 33 seconds). Conclusion: Based on our results, the optimal incision size for increasing Mentor smooth, round, moderate plus volumes is as follows: 2.5 cm for 100-cm3 implant, 3 cm for 200-cm3 implant, 3.5 cm for 300-cm3 implant, 4 cm for 400-cm3 implant, 4.5 cmfor 500- to 700-cm3 implant, and 5 cm for 800-cm3 implant. This guideline can be used to provide the most aesthetic results without tissue compromise. [ABSTRACT FROM AUTHOR]