Dr. Becker lectures at SICAAAMS, Cutting Age Congress in Geneva Switzerland
Topics for the lectures included:
Adjustable breast implants
Use of Adjuastable Breast Implants in cosmetic surgery
Hilton Becker M., D., FACS Boca Raton, Florida, USA
Breast implants have been available for over 30 years. Although results have improved greatly – four remaining problems persist:
1. Size selection
4. Capsular Contracture
Evolution of the adjustable implant:
1. Saline implants – intra operative adjustable
2. Adjustable implants – post operative adjustment
a. Single lumen – Saline
b. Double lumen – 25% gel
c. Anatomical - 35% gel
Adjustable implants have found application in various cosmetic breast surgery procedures including;
1. Routine breast augmentation
2. Mastopexy Augmentation
3. Patients with pre existing asymmetry and tubular breasts.
4. Treatment of breast implant complications, capsular contracture, symmastia, double bubble deformity.
5. Under filling allows capsulodesis to heal prior to final filling.
6. Over expansion corrects residual deformities and improves shape.
Patient becomes an active participant in the outcome of her surgery and they are pleased to be part of the decision making process
Adjustable implants add a new dimension to cosmetic breast surgery, converting a static procedure into a dynamic one. It should be considered in any patient with a particular situation beyond the norm, difficult cases and revisions. Patients acceptance of the technique is gratifying, and the ability of post operative volume adjustments is re assuring to the surgeon
The use of synthetic mesh in breast augmentation:
Synthetic surgical mesh has been widely used in hernia repair ,pelvic floor reconstruction and abdominal wall repair.
With the advent of acellular dermal matrices, the use of these biological meshes have gained popularity in reconstructive and cosmetic breast surgery procedures.
Due to restraints and complications with acellular dermal matrices, we have resorted to the use of synthetic meshes in breast surgery cases
Several types of meshes are currently available that are suitable for use in breast surgery, these include absorbable ,non- absorbable and combination meshes
We report on the use of synthetic mesh in over 50 cases
The categories of breast surgery include breast augmentation astopexy , augmentation mastopexy and revisional breast surgery
Initially non absorbable mesh was used this included prolene (Ethicon) and infinite mesh (gore).These meshes proved to be too rigid. Ultrapro (Ethicon) which is a combination mesh –(Proline and absorbable Monocryl )was then used , this mesh was still found to be too rigid. Absorbable mesh –Vicryl (Ethicon) was used , but only had a temporary effect.
Recently developed long term absorbable meshes were then used.Bio A ( Gore) ,a scaffold material was used .Due to its rigity it had to be meshed and was found to have little long term effect
Over the last year we have been using TIGR® Matrix Surgical Mesh(Novus Scientific) ,a copolymer of glycolide, lactide and trimethylene carbonate. It is a long term absorbable mesh that retains 50% of its strength for up to nine months and is completely resorbed in three years. It has sufficient strength to hold tissues in position until tissue integration has taken place. It also stimulates collagen synthesis which appears to be an added advantage
The success rate has been encouraging with a low incidence of complications these include
Increased seroma formation
one case of infection
Other early complications seen include loss of infra-mammary fold, recurrent ptosis and rippling in patients with very thin skin flaps
Means of preventing these complications are discussed. They include adequate post operative drainage, deep placement of mesh with sufficient coverage , and preparation of capsular tissue prior to placement in revision cases
Management of breast implant complications
Breast Augmentation complications can occur early or late
e. Implant Malposition
f. Rippling – Scalloping
g. Capsular contracture
h. Extrusion, ruptured or deflation.
i. Ptosis – Glandular ptosis or implant ptosis
j. Muscle distortion of implant seen with sub muscular placement and Double bubble deformity
They may be
1 Implant related.
2. Surgery related
3. Patient related
1. Silicone gel – smooth – round
Textured – round or anatomical
2. Saline – smooth
3. Adjustable – round (smooth and textured)
Double lumen 25% gel smooth and textured
50% gel smooth and textured
90% gel smooth and textured
Anatomical 35% gel textured
1. Incision – inframammory
2. Position – sub glandular
1. Increased bleeding tendency
2. Cigarette smoking
3. Capsular contracture – unknown factors
Treatment modalities discussed:
1. Drainage of hematomas and seromas – closed management or open drainage
2. Management of infection – Drainage and irrigation
3. Implant exchange
4. Pocket change
5. Mesh support
6. Open capsulotomy/capsulectomy
7. Post operative expansion with adjustable implants for correction of asymmetry an
8. Correction of asymmetry and implant positioning
9. Capsular contracture
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