Breast implants from 1957 changed on 2005: a 48-year exceptional and historical follow-up

A 78-year-old woman underwent a breast implants removal on August 2005. The prosthetic breast augmentation was performed during 1957, in France. The photos of these polyethylene made breast implants are shown.     

The permanent expandable implant in breast aesthetic,corrective and reconstructive surgery

Summary Since 1986 we have considered the permanent expandable implant (PEI) as the first choice of prosthesis breast surgery. The possibilities offered by multiple over-expansions and deflations have been explored; 187 PEI were utilized in 136 patients for aesthetic (32 with bilateral hypoplasia), corrective (17 with asymmetry, tubular breasts or Poland's syndrome) and reconstructive breast surgery (87 patients for immediate or delayed reconstruction following radical, modified radical, partial or subcutaneous mastectomy). All implants were positioned submuscularly; a latissimus dorsi muscular flap was transposed when the pectoralis major was absent or damaged. Either the Becker or the Gibney implant was used. The filling port was retained in order to take permanent advantage of the properties of the PEI. The dome was placed deep in the axilla, where it could not readily be palpated by patients. All PEI were immediately or progressively overinflated by 25–80% and then deflated to the planned optimal volume. Twenty-two patients developing capsular contracture were treated by overinflations and deflations with subjective and objective improvement. Many of the augmentation mammaplasty patients refused implant deflation to the planned preoperative volume. The over-expansion/deflation process proved to be effective in obtaining ptosis, in maintaining permanent volume symmetry and in keeping the base of tubular breasts unfolded. Moreover, the psychological advantages of patient's involvement in the procedure are significant.     

Advantages of the superior areolar approach for tuberous breast II and III correction with implants

Tuberous breast is a mammary malformation that remains difficult to treat in most cases. It results from an abnormal development of the mammary base, mainly at the lower pole of the breast. The superficialis fascia is adherent to the dermis and deep plane. For type II and III of Grolleau's classification, we were confronted by some difficulties with inferior areolar approach as in Puckett's or Ribeiro's techniques. We had frequently an insufficient glandular volume at the inferior part of the breast and an early look of a "double bubble" deformity. We propose a technical modification to these procedures using a superior hemiareolar approach to place the implant. Associated with an incision of the deep part of the superficialis fascia, it provides a good-shaped lower pole of the breast by preserving glandular volume at this part and reduces the apparition of "double bubble". We operated on 14 types II-III tuberous breasts on nine female patients and had no significant complication. The mean follow-up is 36 months and the results were very satisfying for the patient and her surgeon.     

Correction of established capsular contractures with polyurethane implants

Twelve patients with severe and recurrent capsular contractures following breast augmentation and reconstruction were improved with polyurethane-covered implants. It still has not been established whether these implants prevent or merely delay the onset of contractures, but some of these patients have been followed for over three years and all 12 were improved.Presented at the 9th Congress of the International Society of Aesthetic Plastic Surgery, New York, October 11–16, 1987     

Endoscopic harvesting of the latissimus dorsi flap in breast reconstructive surgery. Feasibility study and review of the literature

STUDY AIM: Breast reconstructive surgery with latissimus dorsi flap is routinely performed with a long dorsal scar ransom. To reduce the scar the authors propose an endoscopic technique to harvest the pure latissimus dorsal flap. We evaluate our first experience. PATIENTS AND METHODS: Between April 2001 and december 2001, 13 patients were operate using an endoscopic pure muscular latissimus dorsal flap for breast reconstruction surgery. RESULTS: Mean operative time is 116 min. No open conversion was necessary. One patient was transfused. The average lymphatic drainage was of 2520 ml with removal of the drainage on postoperative day 15. CONCLUSION: The endoscopic harvesting of the latissimus dorsi pure muscular flap, brings less scar than the open surgery.     

Alteration of general state in a woman with polyethylene breast implants since 1967. About an exceptional clinical case

We report the case of a patient with mammary implants for 42 years. She presented for three years a change of the general state with clinicobiological demonstrations of indefinite origin, and a progressive bilateral increase of her mammary volume until it became exceptional. The surgery of explantation allowed the retreat of two masses of almost 6kg. The analysis did not put in evidence any malignant process but confirmed that it was about prostheses in polyethylene. In one year of recession, a considerable improvement of her general state was observed.     

Biomechanical properties of skin during tissue expansion for breast-reconstructive surgery

Mammary reconstruction following mastectomy involves breast augmentation, which probably sets the skin under tension. This aspect of mechanobiology has rarely been explored in an objective way. The aim of the present study was to measure the biomechanical properties of skin using a suction method. Eight sites of the thorax were assessed in 26 cases of mastectomy performed in 20 women aged 49+/-7 years. In order to distinguish the effects of breast augmentation from forces exerted by earth gravitation, measurements were performed in standing and lying down positions, both before and after breast augmentation of about 450 ml.     

Acellular dermal matrices: Use in reconstructive and aesthetic breast surgery

Acellular dermal matrices (ADMs) were first described for use in breast surgery in 2001. Since this initial report, ADMs have become an increasingly common component of implant-based breast procedures. ADMs have shown promise for use in both aesthetic and reconstructive breast surgery; however, concerns about their use remain because of the significant costs associated with these products. The present article reviews the history of ADM use in breast surgery and the outcomes reported to date. Common techniques for placement of ADMs in aesthetic revisionary and breast reconstruction surgery are provided, and use in the setting of chest wall irradiation and capsular contracture is discussed. Finally, the authors comment on the cost implications of these products in the Canadian and American health care systems.     

Informed consent: considerations in aesthetic and reconstructive surgery of the breast

A definite standard of care exists for establishing informed consent. The plastic surgeon has an obligation to meet these requirements with each patient undergoing surgery. The difficulties of adequately informing have been described and suggestions made for supplementing the consultation with a variety of adjuncts. The goal is to inform and use whatever methods are effective in achieving this goal. Establishing valid informed consent will not prevent all medical liability claims. Despite the most conscientious efforts to inform, some claims will still occur alleging "lack of informed consent." The surgeon must then prove that sufficient information was provided. However, many patients who feel that the surgeon made every effort to inform and felt that the surgeon was honest, conscientious, concerned, and thorough will be less inclined to generate claims even in the face of unsatisfactory results or untoward complications. Informed consent is the patient's right and the surgeon's obligation. The medicolegal benefits from fully informing are tangible and one of the most effective methods to reduce claims and modify risk.     

Acellular dermal matrices: economic considerations in reconstructive and aesthetic breast surgery

This article is a review of cost considerations and outcomes pertaining to the use of acellular dermal matrices (ADMs) in reconstructive and aesthetic breast surgery. The history of the use of ADMs in breast surgery and all case series describing outcomes and use of ADM in breast reconstructive and aesthetic surgery are reviewed. Weighted averages for clinically relevant outcomes for reconstructive and aesthetic breast surgery are provided. Cost considerations of ADM use in breast surgery are described and as an example, a single institution's experience with implementation of ADM into a preexisting breast surgery program, is used.