Adjustable Breast Implants for Asymmetry and Ptosis

Published on 22/05/2015 by admin

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Last modified 22/05/2015

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CHAPTER 35 Adjustable Breast Implants for Asymmetry and Ptosis

Summary/Key Points

1. Breast asymmetry is usually present in most patients. Due to the difficulty in selecting the appropriate size and shape of implant, asymmetry is inevitably seen postoperatively. Adjustable implants offer a means of addressing this problem.

2. Adjustable breast implants are available in single and double lumen containing 0%, 25%, 35%, 50% and 100% silicone gel.

3. The new Spectra Becker adjustable gel implant is a unique implant offering the ability to use a gel implant containing no saline or with a small volume of saline – up to 20% to adjust volume and projection.

4. The fill tube ² injection dome in adjustable implants may be pulled on the operating table, buried under the skin or exteriorized.

5. The same techniques used with gel implants are applicable to adjustable gel implants.

Introduction

For the experienced surgeon, breast augmentation would appear to be a fairly simple operation. However, beware simple solutions to complex tasks: analyzing the dynamics of the procedure yields a markedly different perspective. Consider that we are charged with implanting a soft synthetic material into the body, then assuring that the implant remains soft and, at the same time, retains its shape over a period of many years. Furthermore the breasts should be symmetrical in volume, shape, and projection, and remain so over time – even though our surgical experiences and anatomical knowledge base have shown us that an individual’s breasts vary in all of these dimensions. And we have so far only spoken of normally shaped breasts. Patients with breast ptosis, or with base constriction, also referred to as tubular breast, and patients with severe asymmetry (Poland’s syndrome: absence of the sternal portion of the pectoralis major with ipsilateral upper extremity anomalies) only deepen the complexities for a procedure that clearly is not ‘simple.’

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.¹^–³

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 35.1–35.5 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.

Fig. 35.1 A Preoperative patient with asymmetry and scoliosis. B Showing scoliosis. C Lateral. D Following bilateral breast augmentation with Spectrum® implants. E Volume adjusted postoperatively. F, G Final result.

Fig. 35.2 A Patient with breast asymmetry and ptosis. B Preoperative oblique view. C Preoperative lateral view. D Skin marking for mastopexy and Spectrum® implant insertion. E Two days postoperative following subareolar mastopexy and submuscular Spectrum® placement. F Implant filled via external injection dome. G External injection dome removed. H Final result. I Final result oblique view.

Fig. 35.3 A Patient following previous mastopexy with short nipple inframammary crease distance. B Oblique view. C

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