Augmentation mammoplasty



What incisions are used in augmentation mammoplasty?

Usually three types of incisions are used for augmentation mammoplasty. The periareolar semicircular incision is over the nipple-areola complex. The inframammary incision is placed in the inframammary fold. The axillary incision is placed in the axilla. Each of these methods has benefits and drawbacks. With the periareolar incision scarring is usually minimal but there may be increased alterations in nipple sensation. The inframammary provides excellent exposure, respecting the mammary gland, but it can lead to a more noticeable scar. The axillary incision leaves a good scar, although exposed, but hinders access to the surgical field, limiting the type and volume of implants that can be placed and hindering the successful creation of the pocket.

 

Should prophylactic antibiotics be used?

The incidence of infection in augmentation mammoplasty is 2.2%. As the implant is a foreign body, infection can be a catastrophic event that requires removal. The most frequently isolated microorganism is taphylococcus epidermidis. Therefore, in addition to proper skin preparation appropriate intravenous antibiotics (cephalosporins) should be given in the intervention and orally as postoperative treatment for 5-7 days.

 

What are the operative risks?

All surgical procedures have inherent risks, including bleeding and infection. The hematoma occurs in augmentation mammoplasty in 0.5-3% of cases. If large they require drainage. The incidence of infection is pproximately 2.2% in some series. Poor positioning of the implant, asymmetry, improper placement or the inframammary fold or healing problems can also occur.

 

Is there a change in nipple sensitivity after augmentation mammoplasty?

The sensitivity of the nipple-areola complex is due mostly to the fourth lateral intercostal nerve (nerve branch that lies between the 4th and 5th rib). The nerve reaches the breast approximately 2 cm from the lateral edge of the gland. The incidence of nerve injury in the placement in the subglandular plane (behind the gland) is in some series up to 15%: the placement of the implant in the submuscular plane is much less common.

 

How is capsular contracture classified?

Since 1975 we classify capsular contracture in 4 degrees described by Baker:

  • Grade I: Soft Mama.
  • Grade II: Minimum contracture, implant palpable but not visible.
  • Grade III: Moderate contracture, palpable implant and distinguishable.
  • Grade IV: Severe contracture; hard symptomatic breast, sometimes with shape distortion.

The incidence of contracture is highly variable, and it depends on the type of implant, and the placement plane. If the contracture is symptomatic, treatment to remove the cap and replace the implant is reoperation..

 

What is the average increase in size after augmentation mammoplasty?

The increase in the size of the breast depends on many factors, including the condition of the skin of the breast. Patients with smaller breasts have less skin available and those with involutional atrophy have more, which allows the use of a larger implant. The increase can be performed in stages with a smaller implant serving as a tissue expander with subsequent placement of a larger implant. Other factors include body habitus, shape and size of the breast and implant size

 

Has the incidence of cancer in patients who have undergone a breast augmentation increased?

In the general population, the risk of breast cancer is about one in nine women. It is estimated that nearly two million have undergone augmentation with silicone gel implants. 200,000 of this subpopulation is expected to develop breast cancer. However, numerous studies have shown that patients with breast implants have not undergone an increase in the incidence of breast cancer compared to the non-operated.

 

Is there a risk of breast implant breakage?

All manufactured devices have a finite life expectancy. Patients should be warned that the risk of implant breakage depends on the physical properties of the device and the time elapsed since placement. The risk is cumulative and it is speculated to be about 2% per year. The most appropriate imaging test to assess the condition of the implant is MRI. Faced with a broken prosthesis the attitude to adopt has to be the intervention to change it.