Back-to-Front Flipping of Implants Following Augmentation Mammoplasty and the Role of Physical Characteristics in a Round Cohesive Gel Silicone Breast Implant: Retrospective Analysis of 3458 Breast Implants by a Single Surgeon

Excerpt

Augmentation mammoplasty is one of the most commonly performed procedures today by plastic surgeons. Results and outcomes of the procedure depend on appropriate prosthesis selection, pocket selection, and pocket dissection. Available pockets are subglandular [ 1], partial submuscular [ 2], dual plane [ 3], subfascial plane [ 4], and muscle-splitting biplane [ 5]. On the other hand, implant selection is not easy due to the multitude of available implant shapes, sizes, texturing, gel-fill ratios, and profiles. The choice may run into thousands when all of the available products of various manufacturers are added. Fewer available pockets and familiarity with them makes it easier to select a pocket; however, the battle to select and find an ideal implant is far from over. Comparative parity between the breast width and the implant dimension is of paramount importance regardless of the physical characteristics of an implant or pocket. However, the fine details of the result are in the interaction between breast envelopes, physical characteristics of the implant, and a carefully dissected pocket. The two most commonly used implant fillers are saline and silicone. These implants may have a smooth, microtextured, or textured surface and are available in an anatomical shape, with low, moderate, high, and extra high profiles with different gel-fill ratios. As opposed to the subpectoral plane used for saline implants, silicone implants can be placed in either subglandular or subpectoral pockets, depending on the soft tissue characteristics of the breast envelope. The criterion of envelope adequacy usually is measured by a pinch test [ 3], although the long-term reliability of the pinch test needs to be carefully assessed [ 6]. …