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Augmentation Mammoplasty

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1895 Czerny: Back lipoma submammary. 1962 Cronin/ Gerow: Silicone ... Soft elastic bra or ACE wrap. Augmentation Mammoplasty. Postoperative considerations ... – PowerPoint PPT presentation

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Title: Augmentation Mammoplasty


1
Augmentation Mammoplasty
  • R. Dale Reynolds, MD
  • UT Houston
  • Plastic and Reconstructive Surgery

2
Augmentation Mammoplasty
  • History
  • 1895 Czerny Back lipoma ? submammary
  • 1962 Cronin/ Gerow Silicone
  • 1992 FDA Cancer, replacement
  • 2003 FDA

3
Augmentation Mammoplasty
  • Anatomy
  • Parenchyma

4
Augmentation Mammoplasty
  • Anatomy
  • Blood supply

5
Augmentation Mammoplasty
  • Anatomy
  • Nerve supply

6
Augmentation Mammoplasty
  • Anatomy
  • Fascia

7
Augmentation Mammoplasty
  • Anatomy
  • Muscle

8
Augmentation Mammoplasty
  • Patient Assessment
  • Motivation
  • Younger
  • Older
  • Normal size

9
Augmentation Mammoplasty
  • Considerations
  • Scars
  • Oncologic
  • Sensation
  • Pragnancy/ Lactation
  • Ptosis
  • Symmetry

10
Augmentation Mammoplasty
  • Planning

11
Augmentation Mammoplasty
  • Planning
  • Size
  • Larger chest
  • Skin envelope
  • Projection
  • Asymmetry
  • Implant type
  • Smooth
  • Textured

12
Augmentation Mammoplasty
  • Planning
  • Markings
  • Incision
  • Inframammary fold
  • Periareolar
  • Axillary

13
Augmentation Mammoplasty
  • IMF
  • Advantages
  • Preserves parenchyma
  • Precise pocket
  • Scars well
  • Best candidates
  • Well-defined IMF
  • No h/o hypertrophic healing
  • Mild ptosis
  • Sports (elevate arms)

14
Augmentation Mamoplasty
  • Periareoloar
  • Advantages
  • Scars well
  • Disadvantages
  • Must be AT JUNCTION
  • Non-expandable difficult
  • Bacterial seeding ?
  • Best candidates
  • Areola diameter 35 cm
  • Thin layer of breast parenchyma
  • Technique
  • Superficial to superficial layer of superficial
    fascia to lower border of breast then into
    sub-pectoral space

15
Augmentation Mammoplasty
  • Axillary
  • Advantages
  • Hidden scar
  • Disadvantages
  • More difficult with rough surfaces
  • Need endoscope or blind
  • Revision requires different incision
  • Best candidates
  • Tendency to hypertrophy
  • Marked hypoplasia with poor IMF
  • Technique
  • Mark 1.5-2 cm below IMF

16
Augmentation Mammoplasty
  • Planning
  • Position
  • Subglandular
  • Good with moderate ptosis
  • Active body builders
  • Submusculofascial
  • Decreased contracture
  • Softer
  • Better oncologically

17
Augmentation Mammoplasty
  • Technique
  • Age
  • Skin quality
  • Ptosis
  • Desired size
  • Rough moves less

18
Augmentation Mammoplasty
  • Options

19
Augmentation Mammoplasty
  • Submusculofascial
  • IMF

20
Augmentation Mammoplasty
  • Submusculofascial
  • Periareolar

21
Augmentation Mammoplasty
  • Submusculofascial
  • Axillary

22
Augmentation Mammoplasty
  • Subglandular
  • Considerable ptosis
  • Bodybuilders

23
Augmentation Mammoplasty
  • Subglandular
  • IMF

24
Augmentation Mammoplasty
  • Subglandular
  • Periareolar

25
Augmentation Mammoplasty
  • Ancillary Procedures
  • Intraoperative expansion
  • TE or manually
  • Can use expander as estimate of
    volume
  • Postoperative expansion
  • Permanent expander implant
  • Can alter final volume
  • Abdominoplasty
  • Difficult through same incision
  • Biopsies
  • Preop studies for all 30yo or younger if at
    higher risk
  • NO FAT INJECTIONS
  • Can calcify

26
Augmentation Mammoplasty
  • Postoperative Considerations
  • Care
  • Soft elastic bra or ACE
    wrap

27
Augmentation Mammoplasty
  • Postoperative considerations
  • Massage
  • Enlarges pocket
  • Softens
  • Can help parasthesias

28
Augmentation Mammoplasty
  • Postoperative Considerations
  • Hematoma 0.5-3
  • Good hemostasis
  • Immediate post op RTOR
  • Can cause some asymmetry
  • Can occur 1-2 weeks post-op with increased
    activity
  • Sensation 15
  • 4th intercostal NV bundle most important

29
AugmentationMammoplasty
  • Infection 2.2
  • Staph epidermidis most ducts implants
  • Peri-op antibiotics
  • Irrigate with iodine
  • Atypical mycobacteria require removal
    capsulectomy and systemic anti-fungals
  • Bacterial infections can be treated
    conservatively initially ? replace /-
    capsulectomy

30
Augmentation Mammoplasty
  • Capsular Contracture
  • Classification
  • Grade I Soft
  • Grade II Minimal palpable not visible
  • Grade III Moderate palpable and discernible
  • Grade IV Severe hard, symptomatic, /-distortion

31
Augmentation Mammoplasty
  • Capsular Contracture
  • Prevention
  • Type
  • Silicone Bleed contributes
  • Textured Lower incidence, not
    axillary
  • Position
  • Submusculofascial better - ducts not cut
    (inflammation)
  • Blunt dissection
  • Less hematoma, less electrocautery, less necrosis
  • Infection
  • Major cause
  • Pocket
  • Need adequate size, larger for smooth

32
Augmentation Mammoplasty
  • Capsular Contracture
  • Treat remote site infections (URI, UTI)
  • Closed capsulotomy External pressure
    tears capsule
  • Not effective, potential danger
  • Open capsulotomy
  • Asymmetric implant position, best for I or II
  • Open capsulectomy
  • Thick or calcified capsule, also smooth
    subglandular
  • Conversion to submusculofascial
  • Capsulorrhaphy
  • Suture capsule to reposition pocket into breast
    confines

33
Augmentation Mammoplasty
  • Long-Term Results
  • Varying degrees of firmness
  • Not all contractures require correction
  • Replacement Most last 7 15 years

34
END
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