Adjustable Breast Implants for Asymmetry and Ptosis

Published on 22/05/2015 by admin

Filed under Plastic Reconstructive Surgery

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 1875 times

CHAPTER 35 Adjustable Breast Implants for Asymmetry and Ptosis

Patient Selection

When selecting an implant, the surgeon has to consider several factors. What is the patient’s desire for volume enlargement? What outward projection does she envision? Does she have breast ptosis? What is the base diameter of the breast? What is the nipple–inframammary crease distance? Are the breasts symmetrical or asymmetrical? Does the patient have chest wall asymmetry or scoliosis? All of these and other questions influence implant selection.

The vast array of implants available, varying in shape, projection, diameter, and volume, bear testimony to the fact that achievement of symmetry and meeting patient expectations is extremely challenging with the available implants. It is not surprising that surgeons have great difficulty understanding the computations of these parameters and selecting the appropriate implant.

Fortunately, today’s surgeons have adjustable implants available to them. Adjustable implants offer the surgeon the ability to select the implant based primarily on base diameter and then alter the volume and projection intraoperatively or postoperatively. Adjustable implants include single-lumen saline, double-lumen saline-gel, and adjustable gel. These implants offer considerable benefit to surgeons by simplifying implant selection and allowing for subsequent alteration for the treatment of asymmetry noted here.13

Asymmetry and other conditions for which adjustable implants may be best suited are discussed in the paragraphs that follow. Descriptions of the various models of adjustable implants follow the discussion of conditions. The last section of the chapter is devoted to techniques for insertion.

Indications

Asymmetry

Debate continues about the incidence of breast asymmetry. One estimate suggests that asymmetry presents in 80% of the population, to the trained eye, and increases to 100% when measured with the appropriate tools.4 In this line of thought, surgeons often counsel patients that some degree of asymmetry is an inevitable. Moreover, attempts to correct the asymmetry after the first operation often lead to further complications. Use of the adjustable implant offers the surgeon the ability to more effectively manage asymmetry correction.

Some physicians may argue that asymmetry cannot be fully corrected. We would argue that this argument may be valid when using fixed volume implants. However, with adjustable implants asymmetry can be accurately corrected. The adjustable implant can be increased or decreased post implantation, leading to high degrees of correction of asymmetry Figs 35.135.5 illustrate the presence of asymmetry and scoliosis, followed by installation of an adjustable implant, adjustment of volume, after surgery, and satisfactory correction of the breast defects.

Operative Technique

Types of adjustable implants

Technique

The volume of the adjustable implant may be fine tuned at the time of surgery and the fill tube pulled on the operating table. Alternatively, the desired amount of saline may be added at the time of surgery and postoperative adjustment made via the injection dome. Jackson Pratt drains are routinely used. The injection dome may be exteriorized or buried.11,12

References

1 Becker H. Augmentation mastopexy using adjustable implants with external injection domes. Aesth Surg J. 2006;26(4):736-740.

2 Becker H. Use of the adjustable Spectrum implant in aesthetic breast surgery. Innovations Plast Surg. 2005;1:64-81.

3 Becker H. Breast augmentation using the Spectrum implant with exteriorized injection domes. Plast Reconstr Surg. 2004;111(1):1617-1620.

4 Allergan Academy. ASAPS, 2008 (April, San Diego, CA).

5 Becker H. The correction of breast ptosis with the expander mammary prosthesis. Ann Plast Surg. 1990;24(6):489-497.

6 Becker H. Expansion augmentation. Clin Plast Surg. 1988;15(4):587-593.

7 Becker H, Carlisle H, Kay J. Filling implants beyond the manufacturers recommended fill volume. Aesth Plast Surg. 2008;32(3):432-441.

8 Becker H. Subareolar mastopexy: update. Aesth Surg J. 2003;September/October:357-363.

9 Persoff M, Becker H. Choosing size for an augmentation mammoplasty. Plast Reconstr Surg. 2002;109(1):397.

10 Becker H. The dermal overlap subareolar mastopexy: a preliminary report. Aesth Surg J. 2001;September/October:423-427.

11 Becker H. Adjustable breast implants provide postoperative versatility. Aesth Surg J. 2000;July/August:332-334.

12 Becker H. What is adequate fill? Implications in breast implant surgery. Plast Reconstr Surg. 1997;99(2):599.

13 Becker H. Breast expansion augmentation; the expander mammary implant for breast reconstruction. In: Rolf E Nordstrom MD, editor. Tissue expansion. Newton, Mass: Butterworth-Heinemann, 1996.

14 Becker H. How they do it (breast augmentation). Proc Plast Reconstr Surg. (June):1991.